Larutan pencuci hidung salin isotonis tidak terbukti mempercepat waktu transpor mukosilia pada pasien dengan rinosinusitis akut di RSUP Sanglah, Bali, Indonesia

Background: Mucociliary clearance is a significant element of the defence system of the entire respiratory tract. Impairment of the mucociliary clearance serves as a medium for sinonasal infections. Saline nasal irrigation is believed to alleviated rhinosinusitis symptoms by clearing excess mucus, reducing congestion and remove infectious materials from the inspired air. This study aimed to determine the efficacy of mucociliary transport time of isotonic saline nasal solutions in patients with acute rhinosinusitis.

Methods: An experimental study using pre- and post-test with control group design was conducted in this study. Mucociliary transport time was measured by the saccharine test on 20 acute rhinosinusitis patients before and after 7 days’ treatment with intranasal isotonic saline solutions and standard therapy (ciprofloxacin, pseudoephedrine/ triprolidine, ambroxol) for the case group and standard treatment for the control group. Data were analysed using SPSS version 20 for Windows.

Result: The average mucociliary transport time before therapy was 35.5±10.7 minutes and 29.2±7.7 minutes for the case group and control group, respectively. The average mucociliary transport time after therapy was 22.9±8.7 minutes and 18.0 ± 5.6 minutes for case group and control group, respectively. The mean difference mucociliary transport time before and after therapy was 11.0±7.5 minutes and 9.4±5.3 minutes for the case and control group, respectively (p=0.499).

Conclusions: The addition of intranasal isotonic saline solutions in acute rhinosinusitis patients has the same effect of mucociliary transport time with oral medication with the antibiotic, decongestant, and mucolytic without intranasal isotonic saline solutions.

Latar Belakang: Transpor mukosilia merupakan salah satu mekanisme pertahanan saluran pernapasan. Adanya gangguan pada sistem tersebut menjadi predisposisi terjadinya infeksi sinonasal. Larutan pencuci hidung dengan salin isotonis dipercaya dapat mengurangi gejala akibat rinosinusitis dengan cara membersihkan sekret, mengurangi odema dan mengeluarkan bahan-bahan berbahaya yang masuk bersama udara pernapasan. Tujuan penelitian ini adalah untuk menilai efektivitas waktu transpor mukosilia larutan pencuci hidung salin isotonis pada pasien rinosinusitis akut.

Metode: Uji eksperimental dengan desai pre-post test dengan kontrol dilakukan pada penelitian ini. Waktu transpor mukosilia diukur menggunakan uji sakarin terhadap 20 pasien rinosinusitis akut sebelum dan 7 hari sesudah pemberian larutan pencuci hidung salin isotonis dan terapi standar (ciprofloxacine, pseudoephedrine/triprolidine, ambroxol) pada Kelompok Perlakuan dan terapi standar pada Kelompok Kontrol. Data dianalisis menggunakan SPSS versi 20 untuk Windows.

Hasil: Rerata waktu transpor mukosilia sebelum perlakuan pada Kelompok Perlakuan adalah 35,5 ± 10,7 menit dan 29,2 ± 7,7 menit pada Kelompok Kontrol. Rerata waktu transpor mukosilia sesudah terapi adalah 22,9 ± 8,7 menit dan 18,0±5,6 menit berturut-turut pada Kelompok Perlakuan dan Kelompok Kontrol. Median selisih waktu transpor mukosilia sebelum dan sesudah terapi adalah 11,0±7,5 menit pada Kelompok Perlakuan dan 9,4 ± 5,3 menit pada Kelompok Kontrol (p=0,499).

Kesimpulan: Penambahan larutan cuci hidung salin isotonis pada rinosinusitis akut memiliki efek waktu transpor mukosilia yang sama dengan pemberian antibiotika, dekongestan dan mukolitik tanpa larutan cuci hidung salin isotonis.

Perubahan tingkat pengetahuan pasca penyuluhan penyakit menular tuberculosis (TB) terhadap masyarakat di Desa Tojan, Klungkung, Puskesmas Klungkung I, Bali, Indonesia

Background: Tuberculosis (TB) is one of the infectious diseases that still need attention, especially in developing countries where the prevalence is still high. Health promotion is a step that can be done to prepare citizens in terms of their abilities and knowledge regarding TB disease. This study aims to see changes in people's knowledge after health promotion about TB in the village of Trojan, Klungkung, Bali.

Methods: A cross-sectional descriptive study has been conducted to assesses the knowledge responses before and after delivery of material on TB. Health promotion was carried out on April 2^nd 2018 in Banjar Desa Trojan Klungkung. Before giving the material 3 questions were given to 3 participants randomly, then after giving the material for 30 minutes, 3 questions were given to 9 random communities. Data were analyzed using SPSS version 17 for Windows

Results: A total pre-test score was 44.4% while the post-test score was 88.9% where there was an increase of 44.5% after the material was given. In addition, all of the respondents showed a perfect post-test score (100,0%) both in the questions related to the symptoms of TB as well as the route of transmission for TB, respectively,

Conclusion: This study shows that there is an increase in knowledge after the provision of health promotion through post-test evaluation.

Latar Belakang: Tuberkulosis (TB) merupakan salah satu penyakit menular yang masih perlu diperhatikan terutama di negara berkembang dimana prevalensinya masih tinggi. Penyuluhan merupakan suatu langkah yang dapat dilakukan untuk mempersiapkan warga dalam hal kemampuan dan pengetahuan mengenai penyakit TB. Studi ini bertujuan untuk melihat perubahan pengetahuan warga setelah dilakukan penyuluhan mengenai TB di Desa Trojan, Klungkung, Bali.

Metode: Sebuah studi potong lintang deskriptif telah dilakukan untuk menilai respon pengetahuan sebelum dan sesudah penyampaian materi penyuluhan mengenai TB. Penyuluhan dilakukan pada tanggal 2 April 2018 di banjar Desa Trojan Kelungkung. Sebelum pemberian materi diberikan 3 buah pertanyaan kepada 3 peserta secara acak, kemudian setelah pemberian materi selama 30 menit, diberikan 3 buah pertanyaan kepada 9 masayarakat acak. Data dianalisis menggunakan SPSS versi 17 untuk Windows.

Hasil: Total nilai pre-test adalah 44,4% sedangkan nilai post-test adalah 88,9% dimana terjadi peningkatan sebesar 44,5% setelah pemberian materi. Di samping itu, seluruh responden menunjukkan hasil nilai post-test sempurna (100,0%) baik pada pertanyaan yang berhubungan dengan gejala TB maupun jalur transmisi TB, secara berturut-turut.

Kesimpulan: Studi ini menunjukkan bahwa terdapat peningkatan pengetahuan setelah pemberian penyuluhan melalui evaluasi post-test.

Profil pioderma pada anak usia 0-14 tahun di Rumah Sakit Umum Pusat (RSUP) Sanglah, Denpasar periode Juni 2015-2016

Background: Pyoderma is a skin infection caused by bacteria Staphylococcus, Streptococcus, or both of it. Pyoderma often experienced by children which caused he skin resistance against the invasion of pathogenic germs, which not perfect as ts. Pyoderma morbidity in pediatric patients still occurs, especially in developing countries with tropical climates. This study aims to determine the pyoderma profile among children 0-14 years old at Sanglah General Hospital, Denpasar, in June 2015-2016 period.

Methods: A cross-sectional descriptive design using a retrospective approach was conducted in this study. Samples were determined using total sampling technique and this sample using pediatric patients aged 0-14 years in Sanglah General Hospital periods June 201 5to June 2016 who had pyoderma. The data obtained in this study were analyzed descriptively using SPSS version 17 for Windows.

Results: The results founded that there were 347 admissions, 53 patients suffering from pyoderma in Sanglah General Hospital. The majority of patients aged ≤ 4 years were 31 patients (58.5%), followed by the sex of the male as many as 34 patients (64.2%), diagnosis of bullous impetigo 27 patients (50.9%) and the location of lesions on the head of 32 patients (60.4%). Positive results of gram-positive coccus examination were 28 patients (52.8%) followed by the majority of patients getting a combination of topical and systemic antibiotics were 42 patients (79.2%).

Conclusion: According to the data analysis and discussion, it can be concluded that the incidence of pyoderma in children is still quite a lot happening in Sanglah General Hospital during June 2015-2016 period.

Latar Belakang: Pioderma merupakan infeksi kulit yang disebabkan oleh kuman staphylococcus, streptococcus, atau oleh keduanya. Pioderma sering dialami anak-anak, karena daya tahan kulit terhadap invasi kuman pathogen belum sesempurna orang dewasa. Angka morbiditas pioderma pada pasien anak masih cukup terjadi terutama di negara berkembang dengan iklim tropis. Tujuan dari penelitian ini adalah ntuk mengetahui profil pioderma pada anak usia 0-14 tahun di Rrumah Sakit Umum Pusat Sanglah Denpasar periode Juni 2015- Juni 2016.

Metode: Penelitian ini menggunakan studi potong lintang deskriptif dengan desain penelitian retrospektif. Sampel ditentukan dengan menggunakan teknik total sampling, dalam sampel ini yang digunakan adalah pasien anak yang berusia 0-14 tahun di Rumah Sakit Umum Pusat Sanglah Denpasar periode Juni 2015- Juni 2016 yang mengalami pioderma. Data yang diperoleh dalam penelitian ini dianalisis secara deskriptif menggunakan SPSS versi 17 untuk Windows.

Hasil: Hasil penelitian secara deskriptif menunjukan bahwa dari 347 kunjungan, 53 pasien yang menderita pioderma di Rumah Sakit Umum Pusat Sanglah Denpasar. Sebagian besar pasien berusia ≤ 4 tahun sebanyak 31 pasien (58.5%), diikuti dengan jenis kelaminl laki-laki sebanyak 34 pasien (64.2%), diagnosis impetigo bulosa 27 pasien (50.9%) dan lokasi lesi pada kepala yaitu 32 pasien (60.4%). Hasil positif pemeriksaan kokus gram positif sebanyak 28 pasien (52.8%) diikuti dengan sebagian besar pasien mendapatkan kombinasi topikal dan antibiotik sistemik adalah 42 pasien (79.2%).

Kesimpulan: Berdasarakan hasil analisis data dan pembahasan, maka dapat disimpulkan bahwa insidens pioderma pada anak masih cukup banyak terjadi di Rumah Sakit Umum Pusat Sanglah periode Juni 2015-2016.

Gambaran hasil pemeriksaan endoskopi pada pasien dispepsia di Rumah Sakit Umum Pusat (RSUP) Sanglah tahun 2015

Background: Dyspepsia is recurrent and persistent pain or discomfort in the upper abdomen. Dyspepsia can be divided into two, which are organic dyspepsia and functional dyspepsia, respectively. Endoscopy is one of the recommended diagnostic tools for dyspepsia. This study aims to describe the endoscopic results in dyspeptic patients at Sanglah General Hospital.

Method: The quantitative cross-sectional descriptive study design was used. This study used secondary data from medical records. The sample population of this study was patients with dyspepsia who undergone endoscopy procedure at the Sanglah Central General Hospital in 2015 with a total sampling method that resulted in 260 samples. Data were analyzed using SPSS version 21 for Windows.

Results: The sex of the respondents involved in this study were male (50.8%) and female (49.2%), which have almost the same percentage. Nearly half of the study respondents were 41-60 years old (47.7%). About 92.3%, patients were organic dyspepsia and 7.7%, functional dyspepsia. While the most diagnosed endoscopic examination results were gastritis (40.0%) and found in the young age group (≤ 64 years).

Conclusion: Patients with symptoms of dyspepsia are mostly male, young adults, have organic dyspepsia, and the picture of endoscopic examination is dominated by gastritis at a young age.

Latar Belakang: Dispepsia adalah nyeri yang berulang dan menetap atau rasa tidak nyaman di daerah perut bagian atas. Dispepsia dapat dibagi menjadi dua yaitu dispepsia organik dan dispepsia fungsional. Endoskopi merupakan salah satu alat diagnostik yang di rekomendasikan untuk diagnosis dispepsia. Penelitian ini bertujuan untuk mengambarkan hasil endoskopi pada pasien dispepsia di RSUP Sanglah.

Metode: Desain studi penelitian deskriptif kuantitatif cross sectional dengan menggunakan data sekunder dari rekam medis. Populasi sampel penelitian ini adalah pasien dispepsia yang melakukan endoskopi di Rumah Sakit Umum Pusat Sanglah Tahun 2015 dengan metode Total sampling yang menghasilkan 260 sampel. Data dianalisis menggunakan SPSS 21

Hasil: Jenis kelamin responden yang terlibat pada penelitian ini adalah laki-laki (50,8%) dan perempuan (49,2%) dimana memiliki persentase yang hampir sama. Hampir setengah responden penelitian berusia 41-60 tahun (47,7%). Sekitar 92,3%, pasien merupakan dispepsia organik dan 7,7%, merupakan dispepsia fungsional. Sedangkan diagnosis terbanyak pada hasil pemeriksaan endoskopi adalah gastritis (40,0%) dan ditemukan pada kelompok usia muda (≤ 64 tahun).

Kesimpulan: Pasien dengan gejala dispepsia sebagian besar berjenis kelamin laki-laki, berusia dewasa muda, memiliki dispepsia organik, dan gambaran pemeriksaan endoskopi didominasi oleh gastritis pada usia muda.

Tingkat pengetahuan dan sikap tentang hepatitis B pada dokter gigi di Denpasar Utara

Introduction: Hepatitis B virus is a double stranded DNA virus that belongs to hepadnaviridae family. This virus can be transmitted through unsterile medical instruments, unsafe sex, and blood transfusions from hepatitis B infected individuals. This study aims to evaluate the knowledge and attitude of hepatitis B among dentist in North Denpasar.

Method: This study was a descriptive cross sectional study. Data collection was done by using questionnaire. The study population were dentists in North Denpasar. Subject consisted of 28 respondents that were chosen by random sampling. Study was done from November 2016 until January 2017.

Result: Majority of the respondent had a high knowledge level (75%) regarding transmission of hepatitis B. Similar proportion was found for high and low knowledge level regarding prevention of hepatitis B. Most respondent (57.8%) had a low level of knowledge regarding hepatitis B in general. More respondent had a positive attitude regarding hepatitis B (71.4%). Majority of respondent aged <30 years old had a good knowledge (64.2%), meanwhile bad knowledge was found in more respondent for other age group. Based on the characteristic of attitude regarding hepatitis B according to age and gender, it was found that more respondent had a positive attitude in each group.

Conclusion: Results of this study found that most of the respondent had a good knowledge and attitude regarding hepatitis B, but the knowledge in respondent aged over 30 were found to be bad.

Pendahuluan: Virus hepatitis B merupakan virus DNA beruntai ganda yang termasuk dalam famili hepadnaviridae. Penularan hepatitis B terjadi melalui alat medis tidak steril, hubungan seksual berisiko, dan transfusi darah dari individu yang terinfeksi virus hepatitis B. Penelitian ini dilakukan untuk mengetahui tingkat pengetahuan dan sikap mengenai hepatitis B pada dokter gigi di Denpasar Utara.

Metode: Penelitian ini merupakan studi deskriptif cross-sectional dengan metode pengumpulan data melalui kuisioner. Subjek penelitian adalah dokter gigi di Denpasar Utara. Sejumlah 28 sampel dipilih dengan teknik random sampling yang dilaksanakan dari November 2016 hingga Januari 2017.

Hasil: Mayoritas subjek memiliki tingkat pengetahuan yang tinggi (75%) mengenai penyebaran hepatitis B.  Proporsi yang sama didapatkan untuk tingkat pengetahuan tinggi dan rendah mengenai pencegahan hepatitis B. Mayoritas subjek (57,8%) memiliki tingkat pengetahuan yang rendah tentang hepatitis B secara umum. Lebih banyak responden didapatkan memiliki sikap positif terhadap hepatitis B (71,4%). Sebagian besar responden berusia <30 tahun memiliki tingkat pengetahuan yang baik (64,2%), sedangkan tingkat pengetahuan buruk lebih banyak didapatkan pada kedua kelompok usia lainnya. Berdasarkan karakteristik sikap dokter gigi terhadap hepatitis sesuai umur maupun sesuai jenis kelamin, pada tiap kelompoknya didapatkan lebih banyak responden yang memiliki sikap positif.

Simpulan: Hasil penelitian menunjukkan bahwa tingkat pengetahuan dan sikap tentang hepatitis B pada dokter gigi di Denpasar Utara sebagian besar adalah baik, namun pada kelompok usia diatas 30 tahun, tingkat pengetahuan terkait hepatitis B adalah kurang baik.

Faktor – faktor yang berhubungan dengan kejadian anemia pada anak usia 6-59 bulan di RSUD Wangaya, Denpasar, Bali, Indonesia tahun 2019

Background: Anemia is one of the four micronutrient problems in Indonesia. Based on Global Prevalence on Anemia, the Southeast Asian region is one of the areas with the highest prevalence of anemic populations, more than 53.8% of children aged 6-59 months were classified as mild anemia, and 3.6% of them are severe anemia. In the first 1000 day birth gold period, anemia was associated with delays and developmental disorders, both motor and intellectual, which may be irreversible. This study aims to analyze the risk factors for the incidence of anemia to optimize child development.

Objective: To analyze the relations of the risk of age under two years old, low birth weight, underweight, short stunting, and not exclusive breastfeeding, to the incidence of anemia in children aged 6-59 months in Kaswari Room, Wangaya General Hospital, Denpasar in 2019.

Methods: Observational analytic epidemiology design with case-control study. The research subjects were determined by consecutive sampling method and fulfilled the inclusion criteria with a comparison of case and control groups, namely 1: 1. Data were analyzed bivariate by chi-square statistical test and Odds Ratio (OR) at the significance limit of α=5%, and multivariate analysis was performed with logistic regression test. Data was processed using the Statistical Package for Social Science (SPSS) version 23 for Windows program.

Results: The research subjects were 62 samples, consisting of 31 anemia samples, and 31 samples had no anemia. The results showed that there was no significant relationship between the risk of low birth weight and the incidence of anemia (95% CI = 0.80 - 22.29; p: 0.073), the risk of malnutrition with the incidence of anemia (95% CI = 0.81 - 63.85; p: 0.052), and the risk of not exclusive breastfeeding with the incidence of anemia (95% CI = 0.21 - 1.63; p: 0.440). However, there was a significant relationship between the risk of age <2 years with the incidence of anemia (OR 3.870; 95% CI = 1.34 - 11.17; p: 0.022) and the risk of short stature with the incidence of anemia (OR 7.686; 95% CI = 1, 92 - 30.70; p: 0.002). Logistic regression test results obtained significant results in short stature variables (sig 0.020; OR 5.379).

Conclusion: age <2 years and short stature (stunting) have a significant relationship with the incidence of anemia in children aged 6-59 months in Kaswari Room, Wangaya Hospital, Denpasar in 2019.

Latar belakang : Anemia merupakan salah satu dari empat masalah gizi mikro masyarakat Indonesia. Berdasarkan Global Prevalence on Anaemia, regio Asia Tenggara menjadi salah satu kawasan dengan prevalensi tertinggi populasi anemia, lebih dari 53,8% anak usia 6-59 bulan diklasifikasikan anemia ringan, serta 3,6% di antaranya adalah anemia berat¹. Pada periode emas 1000 HPK, anemia berhubungan dengan keterlambatan dan gangguan perkembangan baik motorik maupun intelektual yang mungkin irreversible². Penelitian ini bertujuan untuk menganalisis faktor-faktor risiko kejadian anemia sebagai langkah mengoptimalkan tumbuh kembang anak.

Tujuan : Menganalisis hubungan risiko usia  < 2 tahun, berat badan lahir rendah, gizi kurang (underweight), perawakan pendek (stunting), dan tidak ASI eksklusif, terhadap kejadian anemia pada anak usia 6-59 bulan di Ruang Kaswari, RSUD Wangaya, Denpasar tahun 2019.

Metode : Rancangan epidemiologi analitik observasional dengan desain studi case control. Subyek penelitian ditentukan dengan metode consecutive sampling, serta memenuhi kriteria inklusi dengan perbandingan kelompok kasus dan kontrol yaitu 1:1. Data dianalisis bivariat dengan  uji statistic chi-square dan Odds Ratio (OR) pada batas kemaknaan α 5%, serta dilakukan analisis multivariat dengan uji regresi logistic. Data diproses menggunakan program Statistical Package for Social Science (SPSS) versi 23 for Windows.

Hasil : Subjek penelitian sejumlah 62 sampel, terdiri dari 31 sampel anemia dan 31 sampel tidak anemia. Hasil penelitian menunjukkan bahwa tidak didapatkan hubungan bermakna antara risiko berat badan lahir rendah dengan kejadian anemia (95% CI = 0,80 – 22,29; p:0,073), risiko gizi kurang dengan kejadian anemia (95% CI = 0,81 – 63,85; p:0,052),  serta risiko tidak ASI eksklusif dengan kejadian anemia (95% CI = 0,21 – 1,63; p:0,440). Namun didapatkan hubungan bermakna antara risiko usia < 2 tahun dengan kejadian anemia (OR 3,870; 95% CI = 1,34 – 11,17; p:0,022) dan risiko perawakan pendek dengan kejadian anemia (OR 7,686; 95% CI = 1,92 – 30,70; p:0,002). Hasil uji regresi logistic, didapatkan hasil bermakna pada variabel perawakan pendek (sig 0,020; OR 5,379).

Kesimpulan:  usia < 2 tahun dan perawakan pendek (stunting) memiliki hubungan bermakna dengan kejadian anemia pada anak usia 6-59 bulan di Ruang Kaswari, RSUD Wangaya, Denpasar tahun 2019.

Efek pemberian ekstrak etanol bawang putih (Allium sativum) sebagai hepatoprotektor pada tikus putih jantan galur wistar (Rattus norvegicus) yang diinduksi parasetamol dosis hepatotoksik

Garlic (Allium sativum) is a plant that known to have various properties that can be used in treatment as a hepatoprotective agent. This study aim was to determine the effect of garlic ethanol extract (Allium sativum) in Wistar strain white male rats (Rattus norvegicus) which was induced by paracetamol in hepatotoxic dose. This research is an experimental study with randomized the post-test only control group design with sample consisted of twenty-four Wistar strain white male rats (Rattus norvegicus). The sample were divided into four groups: control groups, group P1 (given garlic ethanol extract 10 mg/kg), group P2 (ethanol extract of garlic was given 20 mg/kg) and group P3 (given the ethanol extract garlic 30 mg/kg). This study for seventeen days. The entire samples were terminated in order to draw blood to examine SGPT and SGOT. The data of SGPT and SGOT examined by One Way ANOVA. Result showed that there was significant difference in SGPT and SGOT values between groups after given ethanol extract of garlic (Allium sativum) (α <0.05). From the analysis we can concluded that garlic ethanol extract (Allium sativum) can be used as a hepatoprotective agent in Wistar strain white male rats (Rattus norvegicus)  induced by paracetamol in hepatotoxic dose.

Gambaran prediktor perforasi pada penderita apendisitis di Rumah Sakit Umum Ari Canti Gianyar, Bali, Indonesia tahun 2018

Background: Acute appendicitis is one of the most common acute abdomen disease. Morbidity and mortality increased when the complications occur. The most severe complication is perforation which can cause peritonitis and sepsis. So it needs to be known as early as possible to prevent deterioration. This study aims to determine the predictor factors of perforation in appendicitis.

Method: This study was retrospective cross sectional design using secondary data from medical records of appendicitis patients treated at Aricanti Hospital, Gianyar in 2018. Total samples are 96 and they were selected by consecutive technique sampling. Data about age, sex, Total Leukocyte Count (TLC), and symptoms duration of appendicitis patients were collected and analyzed using the Chi-square test.

Result: From 96 samples, 33 (34.4%) were perforated appendicitis and 63 (65.6%) were acute appendicitis. Chi-square test results showed that the predictor factors associated with perforated appendicitis were age under 10 and above 49 years (PR = 2.0; X² = 5.474; p <0.05), male more affected than females (X² = 8.800; p < 0.05), TLC more than 18000/mm³ (PR = 3.3; X² = 20.862; p <0.05) and symptoms duration above 24 hours (PR = 4.1; X² = 24.834; p<0.05 ).

Conclusion: Age, sex, TLC, and symptoms duration can be used as predictors for perforated appendicitis. These predictor factors should be evaluated in appendicitis patients to prevent the occurrence of perforation or to provide immediate treatment in cases of perforation.

Latar Belakang: Apendisitis akut merupakan salah satu akut abdomen yang paling sering dijumpai. Peningkatan morbiditas dan mortalitas terjadi bila terjadi komplikasi. Komplikasi yang terberat adalah perforasi apendiks yang dapat menyebabkan peritonitis dan sepsis. Sehingga perlu diketahui sedini mungkin untuk mencegah perburukan. Penelitian ini bertujuan untuk mengetahui faktor prediktor perforasi pada kasus apendisitis.

Metode: Penelitian ini berdesain retrospektif cross sectional dengan menggunakan data sekunder berupa rekam medis pasien apendisitis yang dirawat di RSU Aricanti Gianyar tahun 2018. Sampel pada penelitian ini berjumlah 96 yang dipilih secara consecutive sampling. Data mengenai usia, jenis kelamin, Total Leukosit Count (TLC), dan symptoms duration pasien apendisitis dikumpulkan dan dianalisa menggunakan uji Chi-square.

Hasil: Dari 96 sampel, sebanyak 33 (34,4%) merupakan apendisitis perforasi dan 63 (65,6%) merupakan apendisitis akut. Hasil uji Chi-square menunjukan faktor prediktor yang berhubungan dengan apendisitis perforasi adalah usia dibawah 10 dan diatas 49 tahun (PR=2,0; X²= 5,474; p<0,05), jenis kelamin laki laki (X²=8,800; p<0,05), TLC lebih dari 18000/mm³ (PR=3,3; X²=20,862; p<0,05) dan symptoms duration diatas 24 jam (PR=4,1; X²=24,834; p<0,05).

Simpulan: Berdasarkan hasil uji statistik tersebut dapat disimpulkan bahwa usia, jenis kelamin, TLC, dan symptoms duration dapat dijadikan faktor prediktor terjadinya apendisitis perforasi. Faktor prediktor ini sebaiknya diperhatikan untuk mencegah kejadian perforasi pada pasien apendisitis ataupun memberikan penanganan yang lebih cepat pada kasus perforasi.

Efficacy of topical steroid therapy for phimosis treatment: a systematic review

Background: Circumcision is the gold standard in the management of phimosis cases. Nowadays, there is some basic science research that showed topical steroid might be used to decrease the morbidity of phimosis cases. This research aims to determine which management is more effective in treating phimosis by using a systematic evidence-based medicine approach.

Methods: Literature searching was done to find journals that are deemed appropriate for these cases. We included 3 RCT studies in this review. Critical appraisal was conducted to determine the efficacy of topical steroid. We compared those two methods in managing cases of phimosis among children.

Results: Topical steroids effectively cause the preputium skin be soft and comfortable to retract. In several cases, some patients had difficulty to get retracted. For these cases, circumcision is needed.

Conclusion: Topical steroid is effective in reducing the phimosis signs and symptoms, especially in patients who are younger and less than 3 years old. Further study and meta-analysis should be conducted in Indonesia to determine the effectiveness of this therapy in Indonesia.

The characteristics of neonatal sepsis in Low Birth Weight (LBW) infants at Sanglah General Hospital, Bali, Indonesia

Backgrounds: Neonatal sepsis is a significant cause of mortality and long-term morbidity. The preterm infant has high-risk sepsis and its sequelae. Low birth weight infants were more susceptible to sepsis. Initial infections in neonates may not be identified due to non-specific symptoms and sign with the limited laboratory criteria. This study aims to describe the characteristics of neonatal sepsis in low birth weight infants in the neonatology intensive care unit of Sanglah Hospital.

Methods: A retrospective cross-sectional study was conducted among 168 infants aged zero to 28 days with birth weights <2,500 grams from May 2017 – April 2018 at Sanglah General Hospital, Bali, Indonesia using a purposive sampling technique. The inclusion criteria were sepsis infants who were hospitalized in neonatology care rooms during the study period at Sanglah General Hospital. Variables assessed in this study were sex, location and mode of delivery, birth weight, gestational age, number of parity, length of stay, the onset of sepsis, as well as the outcome. Data were analysed using SPSS version 17 for Windows.

Results: The mortality rate of sepsis in low birth weight infants was 29.8%. Most of the subjects were male (53%), location of delivery at Sanglah Hospital (60.7%), born spontaneously (51.2%), birth weight were 1500-2499 grams (58,3%) and the most gestational ages were 32-36 weeks (44,6%). Early-onset neonatal sepsis (EONS) dominates patients with neonatal sepsis, with a mean length of stay was 23.27±20.32 days. The major infection risk factor was premature rupture membrane (PRM) >24 hours (14.9%), and minor infection risk factor was gestational age <37 weeks (78%), very low birth weight (44.6%) and asphyxia (41.1%). The total blood culture positivity was 38 (22.6%) cases, and Enterococcus faecalis was the most common organism in this study.

Conclusion: The incidence and mortality of neonatal sepsis in LBW infants were still high. The importance of knowledge and awareness of pregnant women about danger signs and the risk of infection can reduce the incidence of early-onset neonatal sepsis. Prevention of healthcare-associated infections can reduce the incidence of late-onset neonatal sepsis.

Prevalensi dan gambaran karakteristik penderita kanker payudara di poliklinik bedah onkologi RSUP Sanglah, Bali, Indonesia tahun 2016

Background: Breast cancer is a malignancy originating from breast tissue. In Indonesia, the prevalence rate of breast cancer is 0.5% or around 61,628, and the incidence of breast cancer in Bali reached 0.6% in 2013. The aetiology of breast cancers are multifactorial, and the main factor is still unknown. This study aims to determine the prevalence and characteristics of breast cancer patients in the Sanglah General Hospital oncology surgery clinic. 

Methods: This study was a descriptive cross-sectional study. The sample used was a patient suffering from breast cancer who visited Sanglah General Hospital's oncology surgical clinic, both outpatient and hospitalization in 2016 and was willing to submit informed consent. Variables assessed in this study were age, education level, jobs, symptoms, history of breast cancer, the staging of breast cancer, and type of medication. Data were analyzed using SPSS version 17 for Windows. 

Results: The results showed the dominant sociodemographic characteristics of respondents in the age range 41-50 years as many as 27 people (42.18%), had an education level equivalent to senior high school 27 people (42.18%), worked as private employees, and there were 23 entrepreneurs (35.93%) from 62 samples. Other characteristics obtained 55 people (85.94%) respondents experienced initial symptoms of lumps in the breast, 13 people (20.31%) respondents had a family history of breast cancer. A total of 13 patients (20.31%) claimed to use herbal medicine, and 7 (10.94%) admitted to undergoing alternative treatment other than treatment in Sanglah General Hospital, Bali, Indonesia. Only 43.75% decided to seek treatment for their own sake. The majority of patients, as many as 41 people (64.06%) were diagnosed in stage III.

Conclusion: People living with Breast cancer at Sanglah Hospital have a younger age compared to the majority of breast cancer sufferers in the world. Lack of knowledge of women about breast cancer itself is one of the causes.

Latar Belakang: Kanker payudara adalah keganasan yang berasal dari jaringan payudara. Di Indonesia kanker payudara merupakan kenker dengan angka prevalensi kejadian 0.5% atau sekitar 61.628 dan kejadian kanker payudara di Bali mencapai 0.6% pada tahun 2013. Penyebab kanker payudara termasuk multifaktorial yang belum diketahui penyebab utamanya. Penelitian ini bertujuan untuk mengetahui distribusi prevalensi gambaran karakteristik penderita kanker payudara di poliklinik bedah onkologi RSUP Sanglah.

Metode: Penelitian ini merupakan penelitian observasional deskriptif cross-sectional. Sampel yang digunakan merupakan pasien yang menderita kanker payudara yang mengunjungi poliklinik bedah onkologi RSUP Sanglah baik rawat jalan maupun rawat inap pada tahun 2016 dan bersedia mengisi informed consent. Variabel yang dinilai dalam penelitian ini adalah usia, tingkat pendidikan, pekerjaan, gejala, riwayat kanker payudara, stadium kanker payudara, dan jenis pengobatan. Data dianalisis menggunakan SPSS versi 17 untuk Windows.

Hasil: Hasil penelitian menunjukkan karakteristik sosiodemografi responden dominan berada pada rentang usia 41-50 tahun sebanyak 27 orang (42,18%), memiliki tingkat pendidikan setara Sekolah Menengah Atas (SMA) sebanyak 27 orang (42,18%), bekerja sebagai karyawan swasta dan wiraswasta sebanyak 23 orang (35,93%) dari 62 orang sampel. Karakteristik lain yang diperoleh, sebanyak 55 orang (85,94%) responden mengalami gejala awal berupa benjolan pada payudara, responden memiliki riwayat keluarga dengan kanker payudara sebanyak 13 orang (20,31%). Sebanyak 13 penderita (20,31%) mengaku menggunakan pengobatan herbal, dan 7 (10,94%) mengaku menjalani pengobatan alternatif selain pengobatan di RSUP. Hanya sebesar 43,75 % yang memutuskan berobat karena keinginan sendiri. Mayoritas penderita terdiagnosis padaa stadium III yaitu sebanyak 41 orang (64,06%).

Kesimpulan: Penderita kanker payudara di RSUP Sanglah memiliki usia yang lebih muda jika dibandingkan dengan mayoritas penderita kanker payudara di dunia. Kurangnya pengetahuan wanita terhadap kanker payudara itu sendiri merupakan salah satu penyebabnya.

Gambaran prevalensi fraktur humerus di Rumah Sakit Umum Pusat (RSUP) Sanglah, Bali, Indonesia periode tahun 2015-2016

Background: Fracture is the cause of a high number of disabilities worldwide. One of the fractures is humerus fracture, often occur because of injury. The classic symptoms of a fracture are a history of trauma, pain and swelling in the fractured bone, deformity, and musculoskeletal malfunction. This study aims to determine the prevalence of humerus fracture in Sanglah General Hospital Centre of April 2015 - December 2016.

Methods: A retrospective descriptive cross-sectional study by secondary data was conducted among 27 medical records of the patient. The sample population of this study were all inpatients with humerus fracture at orthopaedic installation Sanglah General Hospital during April 2015–December 2016. Data were analyzed using SPSS version 21 for Windows.

Results: Most cases were females (51.9%). The age groups of <20 years old and 20-40 years old have the highest frequency (29.6%, respectively). The students had the most common of humerus fracture (33.0%). Closed fracture prevalence was found by 77,8%, and the open fracture was 22,2% from all cases. Management of the most committed to a closed fracture is ORIF while the open fracture is having debridement ORIF as the most committed management.

Conclusion: The most prevalence of humerus fracture at Sanglah General Hospital during the 2015-2016 period was females, age group <20 and 20-40 years old, occurred in students, and closed fracture type.

Latar belakang: Fraktur merupakan penyebab tingginya angka kecatatan di seluruh dunia. Salah satunya fraktur humerus, sering terjadi karena cedera. Gejala klasik fraktur adalah adanya riwayat trauma, rasa nyeri dan bengkak di bagian tulang yang patah, deformitas, gangguan fungsi muskuloskletal, putusnya kontinuitas tulang dan gangguan neurovascular. Penelitian ini bertujuan untuk menentukan prevalensi fraktur humerus di RSUP Sanglah dari April 2015 – Desember 2016

Metode: Penelitian potong lintang deskriptif retrospektif dengan data sekunder dilakukan terhadap 27 catatan medis pasien. Populasi sampel penelitian ini adalah semua pasien rawat inap dengan fraktur humerus di instalasi ortopedi RSUP Sanglah selama April 2015 - Desember 2016. Data dianalisis menggunakan SPSS versi 21 untuk Windows.

Hasil: Sebagian besar kasus adalah perempuan (51,9%). Kelompok usia <20 tahun dan 20-40 tahun memiliki frekuensi tertinggi (masing-masing 29,6%). Para siswa memiliki proporsi fraktur humerus yang paling sering (33,0%). Prevalensi fraktur tertutup ditemukan oleh 77,8%, dan fraktur terbuka adalah 22,2% dari semua kasus. Manajemen yang paling banyak terhadap fraktur tertutup adalah ORIF sedangkan fraktur terbuka mengalami debridemen ORIF sebagai manajemen yang paling banyak.

Kesimpulan: Prevalensi fraktur humerus yang paling banyak di RSUP Sanglah selama periode 2015-2016 adalah wanita, kelompok usia <20 dan 20-40 tahun, terjadi pada siswa, dan tipe fraktur tertutup.

Gambaran kualitas hidup peserta Pos Binaan Terpadu Penyakit Tidak Menular (POSBINDU PTM) dengan kejadian hipertensi di wilayah kerja Unit Pelaksana Teknis (UPT) Puskesmas Abang I, Karangasem, Bali, Indonesia

Background: Hypertension is a disease that is a significant problem in the world. The prevalence of hypertension worldwide based on JNC-7 covers more than two-thirds of individuals after the age of 65 years. Hypertension can have an impact on the quality of life of patients which is influenced by various complications. PTB with the occurrence of hypertension in UPT Puskesmas Abang I, Karangasem, Bali, Indonesia.

Methods: A cross-sectional study with a total sampling technique was conducted to the 5 villages in the Abang I Public Health Services during September-October 2018. A total of 48 respondents who meet the inclusion and exclusion criteria were included in this study. The variables assessed included gender, age group, level of education, occupational status, degree of hypertension, and overall quality of life among respondents based on the SF-36 questionnaire. Data were analyzed using SPSS software version 17 for Windows. 

Results: The gender proportion of females and males did not differ (50.00%). Most respondents were ≥ 65 years-old (54.17%), followed by low education level (85.42%), jobless (52.08%), hypertension (HT) grade II (56.25%), Rerata systolic blood pressure 159.5±18 mmHg, and diastolic blood pressure of 93±8 mmHg. Most respondents have a good quality of life in the domain of physical roles (100.00%), health (58.33%), vitality (60.41%), emotions (64.58%), and mental health (58.33%).

Conclusion: The quality of life among respondents with hypertension at UPT Abang I Public Health Services, Karangasem, Bali, Indonesia showed good results in the domains of a physical role, health, vitality, emotions, and mental health.

Latar Belakang: Hipertensi adalah salah satu penyakit yang menjadi masalah utama di dunia. Prevalensi hipertensi di seluruh dunia berdasarkan JNC-7 mencakup lebih dari dua pertiga individu setelah usia 65 tahun. Hipertensi dapat berdampak pada kualitas hidup pasien dimana dipengaruhi oleh berbagai komplikasi penyertanya. Penelitian ini bertujuan untuk mengetahui gambaran kualitas hidup peserta POSBINDU PTM dengan kejadian hipertensi di UPT Puskesmas Abang I, Karangasem, Bali, Indonesia.

Metode: Penelitian ini menggunakan desain potong lintang dengan teknik Total Sampling pada 5 Desa di Kawasan UPT Kesmas Abang I selama September-Oktober 2018. Sebanyak 48 orang yang telah memasuki kriteria inklusi dan eksklusi dimasukkan dalam penelitian ini. Variabel yang dinilai meliputi jenis kelamin, kelompok usia, tingkat pendidikan, status pekerjaan, derajat hipertensi, dan kualitas hidup responden secara keseluruhan berdasarkan kuisioner SF-36. Data dianalisis menggunakan piranti lunak SPSS versi 17 untuk Windows.

Hasil: Proporsi jenis kelamin perempuan dan laki-laki tidak berbeda (50%). Sebagian besar pasien berusia ≥ 65 tahun (54,17%), diikuti dengan pendidikan rendah (85,42%,), tidak bekerja (52,08%,), hipertensi (HT) derajat II (56,25%), rata-rata tekanan darah sistolik 159.5±18 mmHg, dan tekanan darah diastolik 93±8 mmHg. Sebagian besar responden memiliki kualitas hidup yang baik pada domain peran fisik (100,00%), kesehatan (58,33%), vitalitas (60,41%), emosi (64,58%), dan kesehatan mental (58,33%).

Kesimpulan: Kualitas hidup responden dengan hipertensi di UPT Puskesmas Abang I, Karangasem, Bali, Indonesia menunjukkan hasil yang baik pada domain peran fisik, kesehatan, vitalitas, emosi, dan kesehatan mental.

Faktor-faktor yang berpengaruh pada Indeks Massa Tubuh (IMT) pada anak Sekolah Menengah Atas (SMA) di Kecamatan Buleleng, Bali, Indonesia tahun 2016

Background: Overweight or obesity is a global health problem that is significantly rising, and it can reduce a person’s quality of life, and also his family. Several factors could influence the Body Mass Index (BMI) as a simple indicator to assess obesity. This study aims to know the factors-related to the BMI among Senior High School students in Buleleng District, Bali, Indonesia, in 2016.

Methods: An analytic cross-sectional study using primary data was conducted through direct anthropometric measurements and questionnaires among 164 students at Buleleng District, Bali, Indonesia, in 2016. A stratified random sampling technique was used to enrol the students in Buleleng District that meet the inclusion and exclusion criteria. Variables assessed in this study were gender, age, BMI, parent’s BMI, level of physical activity, and eating habit. Data were analysed using SPSS version 23 for Windows software with a significance level of 0.05.

Results: Females were predominant in this study (54.00%) compared with males (46.00%), followed by age 16 years old (41.00%), average BMI of respondents 31.25 kg/m2, and the average parent’s BMI were 27.25 kg/m2. Bivariate analysis showed there was no significant relationship between physical activity level with student’s BMI (p = 0.330), diet level the student’s BMI (p = 0.550), father’s BMI to the student’s BMI (p = 0.205). However, a significant relationship was found between a mother’s BMI to the student’s BMI (p=0.038) 

Conclusion: A significant relationship was found between mother’s BMI to the BMI of Senior High Scholl students in Buleleng District, Bali, Indonesia, in 2016. According to the result, special attention and counselling on nutritional status against the senior high school students and parents in Buleleng District are necessarily important.

Latar Belakang: Kelebihan berat badan atau obesitas merupakan masalah kesehatan dunia yang memiliki kenaikan secara signifikan, dan dapat mengurangi kualitas hidup seseorang, dan juga keluarganya. Beberapa faktor dapat memengaruhi Indeks Massa Tubuh (IMT) sebagai indikator sederhana untuk menilai obesitas. Penelitian ini bertujuan untuk mengetahui faktor-faktor yang berhubungan dengan BMI di antara siswa SMA di Kabupaten Buleleng, Bali, Indonesia, pada tahun 2016.

Metode: Penelitian potong lintang analitik menggunakan data primer dilakukan dengan pengukuran antropometrik dan kuesioner secara langsung terhadap 164 siswa di Kabupaten Buleleng, Bali, Indonesia, pada tahun 2016. Teknik pengambilan sampel acak stratifikasi digunakan untuk melibatkan siswa di Kabupaten Buleleng yang memenuhi kriteria inklusi dan eksklusi. Variabel yang dinilai dalam penelitian ini adalah jenis kelamin, usia, BMI, BMI orang tua, tingkat aktivitas fisik, dan kebiasaan makan. Data dianalisis menggunakan SPSS versi 23 untuk perangkat lunak Windows dengan tingkat kebermaknaan 0,05.

Hasil: Jenis kelamin perempuan dominan dalam penelitian ini (54,00%) dibandingkan dengan laki-laki (46,00%), diikuti dengan usia 16 tahun (41,00%), BMI rata-rata responden 31,25 kg/m², dan BMI orang tua rata-rata sebesar 27,25 kg/m2. Analisis bivariat menunjukkan tidak terdapat hubungan yang bermakna antara tingkat aktivitas fisik dengan BMI siswa (p = 0,330), tingkat diet BMI siswa (p = 0,550), maupun BMI ayah dengan BMI siswa (p = 0,205). Namun, terdapat hubungan yang bermakna ditemukan antara BMI ibu dengan BMI siswa (p = 0,038).

Kesimpulan: Hubungan yang bermakna ditemukan antara BMI ibu dengan BMI siswa SMA di Kabupaten Buleleng, Bali, Indonesia, pada tahun 2016. Berdasarkan hasil ini, perhatian khusus dan konseling tentang status gizi terhadap siswa SMA dan orang tua di Kabupaten Buleleng merupakan hal yang penting.

Vitamin C and ubiquinone have the same ability in reducing the spermatozoa DNA fragmentation index in infertile men at Doctor Soetomo General Hospital, Surabaya, Indonesia

Background: Infertility is one of the most common health problems in the world. Malefactors contribute to 50% of cases and about 15-30% of infertile men are categorized as unexplained infertility. There have been numerous studies investigating the role of spermatozoa DNA fragmentation in male infertility. Spermatozoa nuclear DNA integrity has been suggested as a better predictor of male infertility and oxidative stress has been known related to it. This study was conducted to determine the oral supplementation of Vitamin C and Ubiquinone in reducing the spermatozoa DNA fragmentation index (DFI) among infertile men. 

Methods: This was an experimental clinical trial with a pre-test and post-test group design. Thirty infertile men were randomized double-blindingly into 3 groups: Vitamin C and Ubiquinone; Vitamin C and Placebo; Ubiquinone and Placebo groups, each treatment was given for 35 days. The DFI was evaluated by Sperm Chromatin Dispersion (SCD) test, before and after treatment. Data were analyzed using SPSS version 21 for Windows.

Results: The average age of respondents was 32.6 years old, followed by 4.6 years of infertility duration in 5.8 years of marriage. Most of the respondents had a normal Body Mass Index (BMI) (46.7%), no smoking history (75.0%), no history of heat (90.0%) or chemical (73.3%) exposure, and diagnosed with primary male infertility (90.0%). Vitamin C group showed a significant reduction in the spermatozoa DFI (95% CI, p<0.05), while the other two groups showed no differences in the spermatozoa DFIs (95% CI, p>0.05). Comparison analysis showed no differences in the reduction of the spermatozoa DFIs (95% CI, p>0.05) among these three groups. 

Conclusion: The recent findings suggest that oral supplementation of vitamin C can reduce the spermatozoa DFI, while ubiquinone and the combination of vitamin C and ubiquinone could not reduce the spermatozoa DFI.

Karakteristik kasus faringitis akut di Rumah Sakit Umum Daerah Wangaya Denpasar periode Januari – Desember 2015

Background: Acute pharyngitis is an infection of the pharynx caused by viruses or bacteria, which is characterized by the presence of a sore throat, exudate, hyperemia, fever, lymph nodes enlargement of the neck, and malaise. The most common etiology are the germs of Streptococci β-haemolyticus, Streptococcal viridans, and Streptococci pyogenes. It can also be caused by viral infections such as influenza and adenovirus. Acute pharyngitis can be transmitted through contact by nasal or droplet infection of people suffering pharyngitis.

Aim: The study aimed to report acute pharyngitis in the Wangaya General Hospital in the period January - December 2015.

Method: This study was an observational study using a descriptive cross sectional design for patients with acute pharyngitis in the Wangaya General Hospital in the period January - December 2015.

Result and Conclusion: Proportion of acute pharyngitis patients based on age at Wangaya General Hospital were the highest in the age group 0-14 years as many as 47 people (55.9%). The lowest proportion is in the age group > 50 years, 16 people (19%). By its sex proportion, the highest was among women, 48 people (57.2%) as against 36 people (42.8%) for men. Based on clinical symptoms proportion in Wangaya General Hospital, throat pain as many as 57 people (67.9%), followed by difficulty of swallowing as many as 47 (55.9%), fever 19 (22.6%), vomiting 18 (21.4%), malaise 17 (20.2%), lymph nodes enlargement 13 (15.5%), and those with a headache 4 (4.8%)

Faringitis akut adalah infeksi pada faring yang disebabkan oleh virus atau bakteri, yang ditandai oleh adanya nyeri tenggorokan, faring eksudat dan hiperemis, demam, pembesaran limfanodi leher dan malaise. Penyebab terbanyak radang ini adalah kuman golongan Streptokokus β-haemolyticus, Streptoccocus viridans dan Streptoccocus pyogenes. Penyakit ini juga dapat disebabkan oleh infeksi virus seperti virus influenza dan adenovirus. Faringitis akut dapat menular melalui kontak dari sekret hidung dan ludah (droplet infection) dari orang yang menderita faringitis.

Tujuan: untuk mengetahui gambaran tentang penyakit faringitis akut di Rumah Sakit Umum Daerah (RSUD) Wangaya Denpasar periode Januari – Desember 2015.

Metode: Penelitian ini merupakan penelitian observasional yang menggunakan rancangan desktiptif cross sectional terhadap penderita penyakit faringitis akut di RSUD Wangaya Denpasar periode Januari - Desember 2015.

Hasil dan Simpulan: Proporsi penderita Faringitis Akut berdasarkan umur di RSUD Wangaya Denpasar yang tertinggi dijumpai pada pada kelompok umur 0-14 tahun, yaitu 47 orang (55,9%). Proporsi terendah terdapat pada kelompok umur >50 tahun, yaitu 16 orang (19,0%). Proporsi penderita Faringitis Akut berdasarkan jenis kelamin di RSUD Wangaya Denpasar yang tertinggi adalah pada perempuan yaitu 48 orang (57,2%). Sedangkan pada laki-laki yaitu 36 orang (42,8%). Proporsi penderita Faringitis Akut berdasarkan gejala klinis yang dialami di RSUD Wangaya yang tertinggi adalah nyeri tenggorok sebanyak 57 orang (67,9% ), diikuti sulit menelan sebanyak 47 orang (55,9% ), demam 19 orang (22,6% ), muntah 18 orang (21,4% ), malaise 17 orang ( 20,2%), kelenjar limfa bengkak 13 orang (15,5% ), dan yang disertai nyeri kepala 4 orang (4,8%)

Topical application of purple cabbage (Brassica oleracea L. var. capitata f. rubra) ethanol cream extract of dermic collagen on male Wistar rats (Rattus norvegicus) exposed to ultraviolet B

Background: Purple cabbage or also known as red cabbage (Brassica oleracea L. var. capitata f. rubra) contains polyphenols, especially anthocyanin (cyanidin-3-diglucoside-5-glucoside). Anthocyanin has a protective effect against radical oxidative superoxide (ROS). Thus it can prevent skin damage caused by ultraviolet (UV)-B radiation.

Aim: The research aims to prove the effectivity of distribution of purple cabbage ethanol cream extract prevented the decrease of dermal collagens on Wistar rats (Rattus norvegicus) exposed to UV-B rays.

Method: This research was arranged with the randomize post-test only control group design. 30 rats were divided into 6 groups containing 5 rats each, there are control group (P1) without distribution of any cream, Treatment Group (P2) with a distribution of base cream (placebo), (P3) sunblock 33 SPF, (P4) 5%, (P5) 10 %, and (P6) 20 % smeared by purple cabbage ethanol cream extract. All groups exposed to UV-B with a total dose of 840 mJ/cm² for 4 weeks. Then a sampling rats skin was done for examining the level of collagen skin with Sirius red staining. The level of collagen was calculated by the percentage of the area of the pixel of collagen and was compared with the pixels of entire dermal tissues.

Result: The result demonstrated that the mean of collagens in The First Group/P1 (57.74%) and P2 (60.84%) decreased more significantly than P3 (82.17%), P4 (68.23%), P5 (76.93%), and P6 (84.54%) following UV-B exposure. The Post Hoc result showed that there was no significant difference in the level of collagen in the control group and placebo group and the sunblock group with the purple cabbage’s ethanol cream extract group of 20% (p>0.05).

Conclusion: the distribution of purple cabbage ethanol cream extract prevented the decrease of dermal collagens on male Wistar rats skin exposed to UV-B.

Sore throat pada siswa-siswi perokok dan non-perokok SMA Kota Denpasar tahun 2017

Background: Sore throat is a symptom that occurs due to the inflammation process that often disrupts everyday activities and decreases the quality of life of the patient. Smoking cigarette is one of the causes of a sore throat. Prevalence of smokers in Indonesia, especially in adolescents has reached 45%.

Aim: This study aimed to find the prevalence of sore throat as well as its tendency on smokers and non-smokers in high school students in Denpasar City and the characteristics of sore throat and smoking behavior.

Method: This is a descriptive study with a cross sectional research design. The samples of this study are students of SMA PGRI 1 Denpasar. The data in this study is primary data, gathered from questionnaires.

Result: Of the 63 samples included in the study, it was found that the prevalence of active smokers among high school students in Denpasar city reached 27% (95%CI: 16.6-39.7) with a higher proportion of men. The sore throat tends to occur more on active smokers with a proportion of 76.5% (95%CI: 50.1-93.2) than non-smokers with a proportion of 63% (95%CI: 47.5-76.8). Smoking behavior was found to have started, mostly, for 12 months with everyday consumption as the majority. The number of cigarettes smoked could reach 16 cigarettes a day.

Conclusion: Sore throat tends to occur more on smokers than non-smokers even though the difference is not a lot. The results of this study are expected to be used to educate adolescents about the harmful effect of smoking cigarette on health, considered on making policies around the consumption of cigarette in students and to be a foundation for further research to find the relationship between smoking behavior and sore throat.

Sore throat merupakan gejala yang terjadi akibat proses inflamasi yang sering kali mengganggu kegiatan sehari-hari dan menurunkan kualitas hidup penderita. Merokok merupakan salah satu penyebab dari munculnya gejala ini. Prevalensi perilaku merokok di Indonesia, khususnya golongan remaja sudah mencapai 45.0%.

Tujuan: Untuk mencari prevalensi sore throat serta kecenderungan nya pada siswa-siswi perokok dan non-perokok SMA kota Denpasar serta mendapatkan karakteristik dari sore throat dan perilaku merokok.

Metode: Penelitian ini bersifat deskriptif dengan rancangan penelitian potong lintang. Sampel pada penelitian ini adalah siswa-siswi SMA PGRI 1 Denpasar. Data penelitian bersifat data primer dengan menggunakan kuesioner angket yang diisi sendiri oleh sampel.

Hasil: Dari 63 sampel yang diikutsertakan dalam peneltiian didapatkan prevalensi perokok aktif SMA kota Denpasar sebesar 27% (95%CI: 16,6-39,7) dengan proporsi pria yang lebih banyak. Sore throat lebih cenderung terjadi pada perokok aktif yaitu 76,5% (95%CI: 50,1-93,2) dibandingkan non-perokok yaitu 63% (95%CI: 47,5-76,8). Perilaku merokok ditemukan paling banyak sudah dilakukan semenjak 12 bulan terakhir dengan frekuensi konsumsi tersering adalah setiap hari dengan jumlah batang rokok yang dikonsumsi dapat mencapai 16 batang perhari.

Simpulan: Sore throat memiliki kecenderungan untuk lebih banyak terjadi pada perokok dibandingkan non-perokok walaupun tidak jauh berbeda. Hasil penelitian ini diharapkan dapat diterapkan untuk mengedukasi pelajar remaja tentang pengaruh rokok terhadap kesehatan, digunakan untuk pertimbangan pembuatan peraturan seputar konsumsi rokok di kalangan pelajar dan menjadi dasar untuk penelitian lebih lanjut untuk menemukan hubungan antara perilaku merokok dengan sore throat. 

Prevalence of colorectal carcinoma based on microscopic type, sex, age and anatomical location in Sanglah General Hospital

Background: Colorectal carcinoma (CRC) is a disease in which epithelial cells in the colon or rectum become abnormal and divide without control, forming a mass called a tumor. Colorectal carcinoma is the fourth most frequent cancer in men after prostate and lung or bronchus cancers whereas in women is the third most frequent cancer after breast and lung or bronchus cancers. Colorectal cancer is a leading cause of cancer death worldwide, accounting for 693,900 deaths in 2012 and is the fourth most frequent cancer in men whereas in women is the third most frequent cancer. In Indonesia amount of rectal cancer were 1407 (5.67%) and 990 cases (3.99%) of colon cancer. Specifically in Denpasar, there are a total of 75 cases (7.11%) of rectal cancer and 38 cases (3.60%) of colon cancer in the year.

Aim: This study aims to know the prevalence of colorectal carcinoma based on microscopic type, sex, age and anatomical location in Sanglah General Hospital in Denpasar from January 2014 to January 2016.

Method: This study used descriptive retrospective research based on the secondary data from patients medical record which was taken at Sanglah General Hospital from January 2014 to January 2016. Population and sample amounted to 275 patients.

Results: This study shows that the highest prevalence of colorectal carcinoma was in a group of age <50 years old with 86 samples (31.3%) and in a male with 163 samples (59.3%). Adenocarcinoma has the highest prevalence of colorectal carcinoma with 270 samples (98.2%). The rectum was the most frequent tumor location with 170 samples (61.8%). In adenocarcinoma, the age group with the highest prevalence of CRC was <50 years with 85 samples (30.9%). The highest prevalence of CRC based on anatomical location and age group was <50 years in the rectum with 57 samples (20.7%).

Conclusion: Most of the CRC was found in age group < 50 years, men had a higher risk to get colorectal carcinoma, adenocarcinoma is the most common microscopic type, and rectum was the most common site of colorectal carcinoma.

Hubungan proteinuria dan batu saluran kemih: studi analitik

Latar Belakang: Batu saluran kemih (BSK) masih merupakan salah satu masalah tersering yang dihadapi urolog. Proteinuria dapat ditemukan pada kondisi gagal ginjal kronis (GGK), infeksi saluran kemih (ISK), keganasan, ataupun BSK. Protein urin diketahui berperan dalam proses supersaturasi dan agregasi BSK. Studi terkini menemukan hubungan protein marker urin dengan BSK pada level molekular setelah proses elektroforesis. Penelitian ini bertujuan untuk mengetahui hubungan proteinuria pada urinalisa dengan BSK.

Metode: Penelitian ini adalah penelitian studi potong lintang dengan subjek pasien poli urologi di RSUD Kardinah, Tegal. Total sampel 200 pasien yang dikelompokkan menjadi 100 pasien BSK dan 100 pasien kontrol. Seluruh pasien dilakukan pemeriksaan ultrasound (USG) sebagai pemeriksaan diagnosis awal, kemudian dilakukan pemeriksaan urinalisa. Proteinuria dianggap positif untuk nilai protein urin +1 sampai +4 dan negatif pada nilai protein urin trace dan negatif. Variabel lain yang dianalisa adalah ISK, ph urin, usia, dan jenis kelamin.

Hasil: Pasien laki-laki memiliki kecenderungan BSK yang lebih tinggi dibandingkan perempuan dengan rasio 1,8:1. Rentang usia kelompok BSK 23-78 tahun dan pada kelompok kontrol 17-85 tahun. Tidak didapatkan hubungan yang bermakna antara proteinuria dengan BSK (p = 0,203). Terdapat hubungan antara ISK dengan BSK (p = 0,002) dan ph urin dengan BSK (p = 0,024). Terdapat hubungan antara ISK dengan proteinuria pada uji univariat dan multivariat (p = 0,000).

Kesimpulan: Tidak didapatkan hubungan antara proteinuria dengan BSK. Terdapat hubungan antara proteinuria dengan ISK. Proteinuria muncul karena proses inflamasi pada kasus infeksi akibat batu. Penelitian lanjutan diperlukan untuk menentukan jenis protein urin yang menjadi inhibitor pada pasien non stone former dan jenis protein urin yang ditemukan pada stone former.

Positive nikolsky sign and “pinpoint lake of pus” in acute generalized exanthematous pustulosis: a case report

Introduction: Acute generalized exanthematous pustulosis (AGEP) is a severe, usually drug-related reaction, characterized by an acute onset of mainly small non-follicular pustules on an erythematous base and spontaneous resolution usually within two weeks. Current report aims to present management of AGEP in our center at Singaraja Regional Hospital, Bali-Indonesia.

Case: A 78 years old woman with a history of acute coronary syndrome, was reported to have a severe allergic drug reaction. Patients reported taking cefixime medication for the past 2 days because of acute bronchitis. The patient was hospitalized because of the complaint, and diffuse miliary pustules were found above the base of erythematous skin. On examination of lesions, the Nikolsky sign was positive on lesions in the back and abdomen without any tenderness. Histopathological examination was suitable for the diagnosis of acute generalized exanthema pustulosis (AGEP). Systemic intravenous corticosteroid with oral antihistamines was choosen as a primary treatment for this patient.

Conclusion: Treatment is based on the removal of the causative drug, supportive care, infection prevention and use of potent topical or systemic steroids

Relaksasi autogenik menurunkan keluhan gastritis pada orang dengan infeksi HIV-AIDS (ODHA) di RSUD Wangaya, Bali, Indonesia

Background: The current society is demanded many obligations and responsibilities in daily life. This situation can affect the mental stress that leads to stress in facing many problems of life. Psychological stress has an impact on system disturbances in the digestive organs such as gastritis. People with HIV/AIDS (ODHA) are often faced with this condition, so one of the efforts that can be done is to do autogenic relaxation. This study aims to determine the differences in gastritis complaints of ODHA people before and after autogenic relaxation. 

Methods: A quasi-experimental study with pre-test and post-test without a control group was conducted among 21 respondents at Countermeasures AIDS at Badung Regency from May-September 2017. Variables assessed in this study were gender, type of works, marital status, the origin of respondents, and the symptoms of respondents before and after autogenic relaxation intervention. Data were analyzed using SPSS version 17 for Windows.

Results: Most of ODHA patients were males (61.9%), followed by working as housewives (28.6%), marriage (81.0%), and living in North Kuta (28.6%). There was a significant difference in the average value of gastritis symptoms before (1.77) and after autogenic relaxation treatment (1.53) (p=0.002). 

Conclusion: Autogenic relaxation therapy can reduce the symptoms of gastritis among ODHA patients at Wangaya Hospital, Bali, Indonesia. 

Latar belakang: Masyarakat saat ini dituntut dengan banyak kewajiban dan tanggung jawab dalam kehidupan sehari-hari. Keadaan ini akan berdampak pada tekanan mental yang mengarah pada stres dalam menghadapi banyak masalah kehidupan. Tekanan mental akan berdampak pada organ pencernaan seperti gastritis. Penderita HIV/AIDS (ODHA) kerap dihadapkan pada kondisi ini sehingga salah satu upaya yang dapat dilakukan adalah melakukan relaksasi autogenik. Penelitian ini bertujuan untuk mengetahui perbedaan keluhan gastritis pada ODHA sebelum dan sesudah relaksasi autogenik.

Metode: Sebuah penelitian eksperimental-semu dengan pre-test dan post-test tanpa kelompok kontrol dilakukan terhadap 21 responden pada Penanggulangan AIDS di Kabupaten Badung dari Mei-September 2017. Variabel yang dinilai dalam penelitian ini adalah jenis kelamin, jenis pekerjaan, status perkawinan, asal responden, dan gejala responden sebelum dan sesudah intervensi relaksasi autogenik. Data dianalisis menggunakan SPSS versi 17 untuk Windows.

Hasil: Sebagian besar pasien ODHA adalah laki-laki (61,9%), diikuti dengan bekerja sebagai ibu rumah tangga (28,6%), menikah (81,0%), dan tinggal di Kuta Utara (28,6%). Ada perbedaan yang bermakna dalam nilai rata-rata gejala gastritis sebelum (1,77) dan setelah perawatan relaksasi autogenik (1,53) (p = 0,002).

Kesimpulan: Terapi relaksasi autogenik dapat mengurangi gejala grastritis di antara pasien ODHA di Rumah Sakit Wangaya, Bali, Indonesia.

Perbedaan kadar serum feritin dengan dan tanpa infeksi Soil – Transmitted Helminth (STH) pada anak sekolah dasar di Pesantren Hidayatullah Tanjung Morawa, Kabupaten Deli Serdang, Sumatera Utara, tahun 2018

Background: Worm infections caused by Soil-Transmitted Helminths (STH) currently remains a public health problem in the world, especially Indonesia. STH infection is a risk factor for iron deficiency and eventually reaches the stage of iron deficiency anaemia in chronic infections. Serum ferritin levels were measured as early detection of loss of iron reserves in the body to prevent anaemia. This study aims to compare serum ferritin levels in elementary school/ibtidaiyah children with and without STH infection.

Method: A cross-sectional study was conducted among 60 children at Pesantren Hidayatullah Tanjung Morawa in 2018. About 30 children infected with STH and 30 children not-infected with STH, who fulfilled the inclusion and exclusion criteria were included in this study. Every child was examined for faeces with the Kato-Katz Method and serum ferritin levels with Cobas e411 (Electrochemiluminescence immunoassay). The results obtained were analyzed by Mann Whitney's test by SPSS version 17 for Windows.

Result: Serum ferritin levels in the group with STH infection were 10-281 ng/ml, whereas, in the group that did not suffer from STH infection, the values were 15 - 283 ng/ml. The median rank between groups was 5.26 (>5), so clinically, there were significant differences between the two groups. But statistically, there was no significant difference between serum ferritin levels between the two groups (p = 0.24), with the significance value of the Mann-Whitney test p <0.05.

Conclusion: The study showed no significant difference between serum ferritin levels between groups of children who had STH infection and groups of children who did not have STH infection.

Pendahuluan: Infeksi cacing yang disebabkan Soil Transmitted Helminths (STH) saat ini tetap menjadi permasalahan kesehatan masyarakat di dunia khususnya Indonesia. Infeksi STH merupakan salah satu faktor resiko terjadinya defisiensi besi dan akhirnya mencapai tahapan anemia defisiensi besi pada infeksi kronis. Kadar serum feritin diukur sebagai deteksi dini hilangnya cadangan zat besi dalam tubuh untuk mencegah terjadinya anemia. Tujuan penelitian ini adalah untuk untuk membandingkan kadar serum ferritin pada anak sekolah dasar/ ibtidaiyah dengan dan tanpa infeksi STH

Metode: Sebuah penelitian potong lintang dilakukan terhadap 60 anak pada Pesantren Hidayatullah Tanjung Morawa pada tahun 2018. Sekitar 30 anak terinfeksi STH dan 30 anak tidak terinfeksi STH dimana telah memenuhi kriteria inklusi dan ekslusi terlibat dalam penelitian ini. Setiap anak dilakukan pemeriksaan tinja dengan Metode Kato-Katz serta kadar serum ferritin dengan alat Cobas e411 (Electrochemiluminescence immunoassay). Hasil yang didapat dianalisa dengan uji Mann-Whitney menggunakan SPSS versi 17 untuk Windows.

Hasil: Kadar serum feritin pada kelompok dengan infeksi STH adalah 10 – 281 ng/ml sedangkan pada kelompok yang tidak menderita infeksi STH di peroleh nilai 15 – 283 ng/ml. Rank median antar kelompok 5,26 (>5), maka secara klinis terdapat perbedaan bermakna antara kedua kelompok. Tetapi secara statistik tidak terdapat perbedaan yang bermakna antara kadar serum feritin antara kedua kelompok (p = 0,24).

Kesimpulan : Penelitian menunjukkan tidak terdapat perbedaan yang bermakna antara kadar serum feritin antara kelompok anak yang mengalami infeksi STH dan kelompok anak yang tidak mengalami infeksi STH.

Peningkatan kadar Mean Platelet Volume-Lymphocyte Ratio (MPVLR) terhadap resiko diabetik nefropati pada pasien dengan diabetes melitus tipe II (DM-2) di RSUP Sanglah, Bali, Indonesia

Background: Diabetic Nephropathy (DN) is Diabetes Mellitus’s microvascular complication with albuminuria and decrease glomerular filtration rate. DN pathogenesis is related with inflammatory process induced by chronic hyperglycaemia. Mean platelet volume (MPV)  and platelet-lymphocyte ratio (PLR) are potential for reviewing systemic inflammation. The combination of MPV and PLR index into MPVLR shows significant results in prognostic patients with diabetes mellitus and acute myocardial infarction and predicted DN. This study aims to determine the MPVLR index of DN risk in type II diabetes mellitus patients at Sanglah Hospital, Denpasar.

Method: Cross-sectional study of 50 DM-2 patients at Sanglah Hospital in 2016. The data is secondary data from the medical records of DM-2 patients according the inclusion and exclusion criteria with purposive sampling technique. Diabetic nephropathy is diagnose based on diagnostic criteria. Complete blood count (CBC) using the CELL-DYN Ruby System. MPVLR is an absolute comparison of the calculation of MPV and total lymphocytes. T-test and Mann-Whitney Test to assess differences mean of data. The MPVLR index for diabetic nephropathy was assessed by Receiver Operating Curve (ROC) and Area Under the Curve (AUC). p <0.05 is statistically significant.

Results: 50 data were grouped into nephropathy and without nephropathy groups. Men is dominant in both groups (p>0.05). The MPVLR ratio was statistically significantly higher in the nephropathy group (5.11 ± 2.20; P = 0.004). The MPVLR index cut point value was 3.835 with a sensitivity value of 73.7% and specificity of 71%.

Conclusion: MPVLR can use as independent predictor of diabetic nephropathy in diabetic patients.

Latar Belakang: Diabetik Nefropati (DN) merupakan komplikasi mikrovaskular Diabetes Melitus dengan albuminuria dan penurunan estimasi laju filtrasi glomerulus. Patogenesis DN berkaitan dengan proses inflamasi terinduksi hiperglikemia kronis. Indeks rerata volume trombosit (MPV) dan rasio trombosit-limfosit (PLR) potensial untuk meninjau inflamasi sistemik. Gabungan indeks MPV dan PLR menjadi MPVLR menunjukan hasil yang signifikan dalam diagnostik prognostik pada pasien diabetes melitus dan infarksi miokardial akut serta menjadi prediktor DN. Penelitian ini bertujuan untuk mengetahui indeks MPVLR terhadap risiko DN pada pasien diabetes melitus tipe II di RSUP Sanglah, Denpasar.

Metode: Studi potong lintang (cross-sectional) terhadap 50 pasien DM-2 di RSUP Sanglah tahun 2016. Data penelitian adalah data sekunder dari rekam medis pasien DM-2 yang memenuhi kriteria Inklusi dan Eksklusi dengan teknik purposive sampling. Diabetik nefropati ditegakkan berdasarkan kriteria diagnosis. Pemeriksaan darah lengkap (DL) menggunakan CELL-DYN Ruby System. Rasio MPV terhadap limfosit (MPVLR) adalah perbandingan absolut dari perhitungan MPV dan limfosit total. Uji-t dan Uji Mann-Whitney untuk menilai perbedaan antara rata-rata data dua kelompok. Indeks MPVLR terhadap diabetic nefropati dinilai dengan Receiver Operating Curve (ROC) dan Area Under the Curve (AUC). Nilai p<0,05 bermakna secara statistik.

Hasil: 50 data dikelompokkan menjadi kelompok dengan nefropati dan tanpa nefropati. Jenis kelami laki-laki dominan di kedua keompok tersebut (p>0,05). Rasio MPVLR secara statistik bermakna lebih tinggi pada kelompok dengan nefropati (5,11±2,20; P=0,004). Nilai titik potong indeks MPVLR sebesar 3,835 dengan nilai sensitifitas sebesar 73,7% dan spesifisitas 71%.

Simpulan: MPVLR dapat sebagai prediktor kuat dan independen diabetik nefropati pada pasien diabetes.

The association between Body Surface Area (BSA) and vitamin D level among obese adolescent patients in Denpasar, Bali, Indonesia

Background: Prevalence of obesity in adolescent in Indonesia is still high. An obese adolescent is likely to stay obese into adulthood and tends to develop into cardiovascular and metabolic diseases. Obese subjects have larger body surface area and should be able to produce more vitamin D from cutaneous synthesis. This study aims to determine the prevalence of obesity in adolescent in Denpasar, determine vitamin D status among obese adolescents and obtained an association between body surface area and vitamin D levels.

Methods: A descriptive observational study using a cross-sectional approach has been conducted among 51 obese adolescents in Denpasar during May to December 2018. Several variables assessed in this study were age, sex, weight, height, Body Mass Index (BMI), Body Surface Area (BSA), and vitamin D levels. Factors associated with vitamin D levels in obese adolescence were analyzed with appropriate statistical analysis. Data were analyzed using SPSS version 17 for Windows. 

Results: From 51 subjects, 32 (62.74%) male and 19 (37.26%) female subjects were enrolled in this study. The mean weight and height of respondents were 89.4±9.8 kg and 158.6±7.3 cm. In addition, the average Body Mass Index (BMI) and Body Surface Area (BSA) were 33.6±3.4 kg/m2 and 2.1±0.2 m2. The mean Vitamin D levels was 18.9±4.9 ng/mL with 40 subjects (78,4%) were known in a vitamin D deficiency state. There was a significant weak positive association between BSA and vitamin D levels (r=0.32; p=0,002).

Conclusion: Most obese adolescents were in vitamin D deficiency with a significant weak positive association between BSA and vitamin D levels. 

Hemiartroplasti Bipolar menghasilkan luaran C-Reactive Protein dan Harris Hip Score yang lebih tinggi dibandingkan Cephalomedulary Nailing

Background: Bipolar Hemiarthroplasty and Cephalomedullary Nailing (PFNA) are operative procedures for the management of proximal femoral fractures. Both of these surgical techniques have their respective advantages and disadvantages. This study aims to determine the differences in biological and functional outcomes. C-Reactive Protein (CRP) used to measure inflammation due to tissue damage and Harris Hip Score (HHS) used to measure functional output. This study hoped to facilitate the selection of appropriate techniques for the treatment of proximal femoral fractures.

Methods: Prospective cohort study conducted among patient with proximal femoral fractures who underwent Bipolar Hemiarthroplasty and PFNA surgery. CRP levels were examined before surgery and 12 hours postoperatively. The HHS assessment was performed at weeks 4, 6, and 8 postoperatively.

Results: In general, the preoperative CRP levels of the groups undergoing Bipolar Hemiarthroplasty and PFNA were not significantly different (32.4±16.7 and 33.7±17.1; p> 0.05), whereas postoperatively, Bipolar Hemiarthroplasty shown significantly higher CRP (76.5±27.3 and 42.6±17.6; p <0.0001). Similar results were also shown from the ∆CRP analysis (45.1±22.1 and 8.9±3.2; p<0.0001). The mean HHS score was higher in the Bipolar Hemiarthroplasty group than in PFNA group at each measurement. At the 4th week, the mean HHS score did not show a significant difference (52.3±4.2 vs 52.2±5.4; p>0.05). The 6th week evaluation showed Bipolar Hemiarthroplasty had a mean HHS of 76.5±4.6 while PFNA 61.4±5.4 (p <0.0001). At week 8, HHS in Bipolar Hemiarthroplasty was consistently higher than PFNA (89.43±4.5 and 74.95±4.9; p <0.0001). The Bipolar Hemiarthroplasty group was hospitalized 56% longer (6.1±1.3 and 3.9±1.3 days; p<0.0001) and the Bipolar Hemiarthroplasty had an average bleeding volume of 4.5 times more (407.4±122.8 and 90±13 ml; p <0.0001).

Conclusion: Bipolar Hemiarthroplasty and PFNA procedures have significantly different functional and biological outcomes. The postoperative HHS score in Bipolar Hemiarthroplasty is better but with a higher delta CRP.

Latar Belakang: Hemiarthroplasti bipolar dan Cephalomedullary Nailing (PFNA) merupakan prosedur operatif penatalaksanaan fraktur proksimal femur. Kedua prosedur tersebut menggunakan pendekatan yang berbeda utamanya pada upaya preservasi bagian proksimal femur. Kedua teknik bedah ini memiliki keuntungan dan kerugian masing-masing. Penelitian ini bertujuan untuk mengetahui perbedaan luaran biologis dan fungsional kedua teknik tersebut. C-Reactive Protein (CRP) digunakan sebagai parameter terkait inflamasi akibat kerusakan jaringan dan Harris Hip Score (HHS) digunakan mengukur luaran fungsional. Studi ini diharapkan dapat mempermudah pemilihan teknik yang tepat untuk penanganan fraktur proksimal femur.

Metode: Penelitian ini adalah penelitian kohort prospektif pada pasien dengan fraktur proksimal femur yang menjalani operasi Hemiartroplasti Bipolar dan PFNA. Kadar CRP diperiksa sebelum operasi dan 12 jam paska operasi. Penilaian HHS dilakukan pada minggu ke-4, 6, dan 8 paska operasi.

Hasil: Secara umum kadar CRP preoperasi kelompok yang menjalani Hemiarthroplasti Bipolar dan PFNA tidak berbeda signifikan (32,4±16,7 dan 33,7±17,1; p>0,05), sedangkan pada paska operasi kadar CRP Hemiarthroplasti Bipolar secara signifikan lebih tinggi (76,5±27,3 dan 42,6±17,6; p<0,0001). Hasil yang sama juga ditunjukan dari analisis ∆CRP (45,1±22,1 dan 8,9±3,2; p < 0,0001). Rerata skor HHS lebih tinggi pada kelompok Hemiarthroplasti Bipolar daripada PFNA pada setiap kali pengukuran. Pada minggu ke-4 nilai rerata HHS tidak menunjukan perbedaan yang signifikan (52,3±4,2 vs 52,2±5,4, p>0,05). Evaluasi minggu ke-6 menunjukan Hemiarthroplasti Bipolar memiliki rerata HHS 76,5±4,6 sementara PFNA 61,4±5,4 (p<0,0001). Pada minggu ke-8, HHS pada Hemiarthroplasti Bipolar konsisten lebih tinggi daripada PFNA (89,43±4,5 dan 74,95±4,9; p<0,0001). Kelompok Hemiarthroplasti Bipolar menjalani rawat inap 56% lebih lama (6,1±1,3 dan 3,9±1,3 hari; p < 0,0001) serta Hemiarthroplasti Bipolar memiliki rerata volume perdarahan 4,5 kali lebih banyak (407,4±122,8 dan 90±13 ml; p < 0,0001).

Kesimpulan: Prosedur Hemiarthroplasti Bipolar dan PFNA memiliki luaran fungsional dan biologis yang berbeda secara signifikan. Skor HHS pada Hemiarthroplasti Bipolar lebih baik tetapi selisih CRP yang lebih tinggi.

Hubungan dan titik potong skor Caprini terhadap D-dimer sebagai parameter resiko trombosis vena dalam pada pasien paska fiksasi internal fraktur tulang panjang ekstremitas bawah

Background: Fractures contribute to a substantial proportion of the emergency department cases. Surgical procedures such as internal fixation of lower limb fractures posed a risk to develop deep vein thrombosis (DVT). The current diagnosis of DVT is still a challenge, as the current main parameter, the D-dimer, requires additional laboratory time and cost. Threrefore, an easier and faster alternative should be used in clinical decision making. Caprini score is among a simple method to assess the risk of a DVT, but validation is still needed before it can be implemented.

Methods: This is an cross-sectional analytic study aimed to determine the relationship between Caprini scores and D-dimer level in patients with post-internal fixation of long bone fractures in lower extrimities at Sanglah Hospital Denpasar. Caprini scores were determined before surgery then D-dimer measurements were taken postoperatively. Statistical analysis was performed using the Pearson correlation method and ROC curve were generated to determine the cut-off point of Caprini Score equivalent of high risk DVT with the D-dimer as the predictor.

Result: The average Caprini score was 9.37 (7-13). Mean preoperative D-dimer was 6.59 µg/ml (2.50-13.20 µg/ml), postoperatively 11.50 µg / ml (3.71-19.89 µg/ml) and mean delta D -Dimer 5.23 µg/ml (0.56-12.28 µg/ml). Pearson correlation test obtained a strong positive relationship (r = 0.726 and p≤0,0001). Analysis of the ROC curve to determine the cut-off point for Caprini score which equivalent to the high risk of DVT from D-dimer prediction (> 7.2 µg / ml) resulted in AUC of 0.824 (95% CI 0.669-0.979, p= 0.024) with the optimal cut-off point for Caprini score was 8.

Conclusion: Caprini and D-dimer scores show a strong positive correlation.  Caprini scores can be considered to estimate the risk of DVT in post-internal fixation patients of lower extremities long bone fractures.

Latar Belakang. Kejadian fraktur memiliki proporsi yang substansial dari total pasien yang datang ke unit gawat darurat rumah sakit. Prosedur operasi seperti pemasangan fiksasi internal pada fraktur ekstremitas bawah memiliki resiko untuk terjadinya trombosis vena dalam (DVT). Penegakan diagnosis DVT saat ini masih merupakan suatu tantangan salah satunya karena pemeriksaan laboratorium D-dimer membutuhkan waktu dan biaya tambahan, sehingga dibutuhkan alternatif yang lebih mudah dan cepat digunakan dalam pengambilan keputusan klinis. Skor Caprini merupakan salah satu cara untuk menilai resiko terjadinya suatu DVT, akan tetapi masih diperlukan validasi sebelum dapat diimplementasikan.

Metode: Penelitian cross-sectional analitik dilakukan untuk mengetahui hubungan Skor Caprini dengan kadar D-dimer pada pasien paska operasi fiksasi internal fraktur tulang panjang ekstremitas bawah di RSUP Sanglah Denpasar. Skor Caprini ditentuakan sebelum operasi kemudian pengukuran D-dimer dilakukan paska operasi. Analisis statistik dilakukan dengan metode korelasi Pearson dan penentan titik potong risiko DVT dengan prediktor D-dimer menggunakan metode kurva ROC.

Hasil: Rerata Skor Caprini adalah 9,37 dengan rentang skor 7-13. Rerata D-dimer sebelum operasi sebesar 6,59 µg/ml (2,50-13,20 µg/ml), paska operasi 11,50 µg/ml (3,71-19,89 µg/ml) dan rerata delta D-Dimer 5,23µg/ml (0,56-12,28 µg/ml). Uji korelasi Pearson diperoleh hubungan positif kuat antara Skor Caprini dengan kadar D-dimer (nilai r=0,726 dan nilai p≤0,0001). Analisis kurva ROC untuk menentukan itik potong  Skor Caprini yang setara dengan resiko tinggi terjadinya DVT dari prediksi D-dimer (>7,2 µg/ml) memperoleh Area Under Curve 0,824 (95% CI 0,669-0,979, p = 0,024) dengan titik potong optimal skor Caprini 8.

Kesimpulan: Skor Caprini dan D-dimer menunjukkan korelasi positif yang kuat pada pasien paska fiksasi internal fraktur tulang panjang ekstremitas bawah. Skor Caprini dapat dipertimbangkan sebagai acuan dalam menentukan resiko terjadinya  DVT.

Pola Mikroba dan Sensitivitasnya Terhadap Antibiotik pada Pasien dengan Infeksi Saluran Kemih di RSUD Prof. Dr. W.Z. Johannes, Kupang Periode Januari-Desember 2017

Background: Urinary tract infection (UTI) is a serious public health problem which involves infection of any parts of the urinary tract. In the past few years, treatment of UTI becomes very challenging due to increase emergence of antibiotics resistance in uro-pathogens. This study was performed to determine microbial patterns and its sensitivity to antibiotics.

Methods: This was an observational descriptive study. The data were collected from 130 urine samples in RSUD Prof. Dr. W.Z. Johannes during period of January-December 2017. Patients were diagnosed UTI by using Vitek 2.

Results: We obtained 130 samples of urine culture in RSUD. Prof. Dr. W. Z. Johannes during period of January-December 2017. From 130 samples of urine culture, 83 samples showed growth of bacteria and fungi (63,85%) whereas 47 samples showed no growth (36,15%). From 83 growth samples, we identified 20 types of bacteria which include 4 types of gram positive bacteria, 16 types of gram negative bacteria and 1 type of fungi. The most common causes of UTI were E. coli (22,89%), Candida albicans (10,84%), Klebsiella pneumoniae ss pneumoniae (9,64%) and Acinetobacter baumanii (6,02%). Meropenem, gentamycin and amikacin were still sensitive to uropathogen. The most common antibiotics which were resistance to bacteria were ampicillin and ceftriaxone.

Conclusion: Escherichia coli is the most prevalence contribute to UTI in outpatient and inpatient. There were only three types of non-resistant antibiotic to uropathogens.

Latar Belakang: Infeksi saluran kemih (ISK) merupakan salah satu masalah kesehatan serius. Beberapa tahun belakangan ini, pengobatan ISK menjadi tantangan tersendiri bagi para klinisi karena tingginya angka resistensi antibiotik. Penelitian ini bertujuan untuk mengetahui pola mikroba dan senstivitasnya terhadap antibiotik.

Metode: Pada penelitian deskriptif observasional ini, didapatkan 130 sampel urin di RSUD Prof. Dr. W.Z. Johannes dari bulan Januari-Desember 2017 dimana pasien didiagnosis ISK melalui pemeriksaan dengan Vitek 2.

Hasil: Sebanyak 130 sampel urin yang dikultur, 83 sampel menunjukan perkembangan bakteri dan jamur (63,85%) dimana 47 sampel menunjukan tidak adanya pertumbuhan (36,15%). Dari 83 sampel yang tumbuh, teridentifikasi sebanyak 20 tipe bakteri dimana 4 tipe merupakan gram-positif dan 16 tipe gram negatif serta 1 tipe jamur. Penyebab terbanyak ISK adalah E. coli (22,89%), Candida albicans (10,84%), Klebsiella pneumoniae ss pneumoniae (9,64%) dan Acinetobacter baumanii (6,02%). Dimana antibiotik jenis meropenem, gentamisin dan amikasin masih sensitif untuk uropatogen. Sedangkan ampisilin dan seftriakson adalah jenis antibiotik yang memiliki angka resistensi tertinggi.

Kesimpulan: Escherichia coli adalah penyebab tersering ISK dan hanya ditemukan tiga jenis antibiotik yang masih sensitif untuk uropatogen.

Hubungan jenis persalinan dengan kejadian asfiksia neonatorum di ruang perinatologi dan Neonatal Intensive Care Unit (NICU) RSUD Wangaya Kota Denpasar

Background: Newborn deaths are still a major health problem and several health efforts have been made to improve children's health. Based on the results of the Indonesian Demographic and Health Survey (IDHS) in 2017, the Neonatal Mortality Rate (NMR) is 15 per 1000 live births. One of some cause deaths is asphyxia or  respiratory problems 36%. Neonatal asphyxia is a condition of a newborn who fails to breath spontaneously and regular immediately after birth. Based on the annual report of the Sanglah Central General Hospital (RSUP) in Denpasar, the percentage of asphyxia events has increased 11.31% in 2014. Factors that cause neonatal asphyxia including maternal factor, infant factor, placental factor and labor factor. The purpose of this study is  to determine the relationship between types of labor with asphyxia neonatorum.

Method: The type of research used is observational analytic study with case-control. In this study, sampling was perfomed at Wangaya Hospital June 2018-December 2018 in the NICU and and Perinatology room until  the number of research samples fullfillig the inclusion and exclusion criteria with 45 cases and 45 samples.The samples was obtained by consecutive sampling method. The case in this research is  neonates who has neonatal asphyxia and controls in this study were neonates who did not have neonatal asphyxia. Data obtained were analyzed analytically, using SPSS 23.0 software using the Mc Nemar test with p value of <0.05 considered significant.

Results: There was no relationship between types of labor with neonatal asphyxia (p = 0.481, OR = 1.429, IK95% = 0.368-5,548).

Conclusion: There is no significant relationship between the type of labor asphyxia neonatorum.

Latar Belakang: Kematian bayi baru lahir masih merupakan masalah kesehatan yang utama dan beberapa upaya kesehatan telah dilakukan untuk meningkatkan kesehatan anak. Berdasarkan hasil Survei Demografi dan Kesehatan Indonesia (SDKI) tahun 2017, Angka Kematian Neonatal (AKN) sebesar 15 per 1000 kelahiran hidup. Penyebab utama kematian salah satunya adalah asfiksia atau gangguan pernapasan sebesar 36%. Asfiksia neonatorum adalah suatu keadaan bayi baru lahir yang ditandai dengan gagal bernafas secara spontan dan teratur segera setelah lahir. Berdasarkan laporan tahunan Rumah Sakit Umum Pusat (RSUP) Sanglah Denpasar, persentase kejadian asfiksia meningkat kembali 11,31% pada tahun 2014. Faktor yang menyebabkan asfiksia neonatorum antara lain faktor ibu, faktor bayi, faktor plasenta dan faktor persalinan. Tujuan dari penelitian ini adalah untuk mengetahui hubungan jenis persalinan dengan asfiksia neonatorum.

Metode: Jenis penelitian yang digunakan adalah studi observasional analitik dengan metode case-control. Pada penelitian ini, pengambilan sampel dilakukan di RSUD Wangaya periode Juni 2018-Desember 2018 di ruang NICU dan dan Perinatologi sampai jumlah sampel penelitian yang memenuhi kriteria inklusi dan ekslusi dengan jumlah 45 kasus dan 45 sampel. Sampel diperoleh melalui metode consecutive sampling. Kasus pada penelitian ini adalah neonatus yang mengalami asfiksia neonatorum, sedangkan kontrol pada penelitian ini adalah neonatus yang tidak mengalami asfiksia neonatorum. Data yang diperoleh dianalisis secara analitik, menggunakan perangkat lunak komputer SPSS 23.0 dengan menggunakan tes Mc Nemar dengan nilai p<0,05 dianggap signifikan.

Hasil: Tidak terdapat hubungan antara jenis persalinan dengan asfiksia neonatorum (p =0,481,OR=1,429, IK95% = 0,368-5,548).

Simpulan: Tidak  terdapat hubungan yang signifikan antara jenis persalinan dengan kejadian asfiksia neonatorum.

Prevalence of risk factors associated with hypertension at Sanglah General Hospital, Bali

Background: High blood pressure, also called "hypertension," is a serious medical condition. It happens when the force of the blood pumping through the arteries is too strong. The World Health Organization rates hypertension as one of the most important causes of premature death worldwide, and the problem is growing. This study aimed to determine the risk factors affecting Hypertension at Sanglah general hospital.

Methods: This study was a descriptive study with a cross-sectional approach. The data used in this study is a secondary data collected from medical record of the patients with Hypertension at Sanglah general hospital, Denpasar, Bali in the year of 2015 until 2016. The data was categorized based on Body Mass Index (BMI), gender, age, alcohol consumption, and history of cardiovascular diseases.

Results: There are 73(60.83%) males and 47(39.17%) females, the majority of patients were in the age group of 18 – 70 years of age with the age group of 40 - 50 carrying a rather large quantity of 45.8% among the male gender and for the female gender the age group of 51 – 60 showed the highest percentage of 38.2%, the sample consists of 60.83% of males and 39.17 of females from the total 120 samples taken from Sanglah general hospital. As for Body Mass Index (BMI), 25 – 29.9 has the most significant value of 49 (40.83%) when compared to the other nutritional statuses present. The patients with the cardiovascular disease showed a very substantial amount of 69 (57.5%) among males and 41 (34.17%) among females. Patients with a history of alcohol consumption for the male gender had a value of 34 (28.30%), and for the female gender group, it carried an amount of 2 (1.70%).

Conclusions: This study succeeded in identifying 120 samples of patients with hypertension and their contributing risk factors. The majority of the Samples were with body mass index (BMI) 25 – 29.9 (40.83%). The samples with a history of cardiovascular disease showed a value of 69 (57.5%) among males and 41 (34.17%) among females. Patients with a history of alcohol consumption for the male gender had a value of 34 (28.30%), and for the female gender group, it carried an amount of 2 (1.70%)

Peranan p53 dalam perkembangan dan prognosis osteosarkoma: tinjauan pustaka

Background: Osteosarcoma is the most common non hematopoietic primary malignant tumor in the bone. Several factors have been related through the development and prognosis of osteosarcoma. One of them is the mutation of p53 gene that encodes p53 protein. This literature review aims to evaluate the role p53 in the progressiveness and prognosis of osteosarcoma.

Methods: A review of relevant literature was performed to elaborate p53 involvement in osetosarcoma. A total of 22 qualified published literature from 2006 until 2017 were collected from several electronic database as well as manual search and included in this review.

Results: P53 has an important role in maintaining genome integrity through its ability to induce genes involved in senescence process, DNA repair and apoptosis. Loss of P53 induces progenitor cells to proliferate and experience differentiation disturbances thereby increasing the potential malignant transformation to osteosarcoma. Loss of p53 also increases osteosarcoma progression by increasing proliferation and providing a good microenvironment for tumor cells. P53 causes inhibition to other tumor suppressor proteins such as BMP-2 and CD137L. Loss of P53 has a role in providing a good microenvironment for osteosarcoma cells to invade surrounding tissue, metastasis and suppressed immune response through increased activity of SDF-1, HIF-1α, VEGF, and NO. High mutant p53 expression has a positive association with short-term survival but does not have a strong association to predict long-term survival.

Conclusion: A p53 gene has a pivotal role in the progressiveness and prognosis of osteosarcoma through increasing proliferation and providing a good microenvironment for tumor cells

Latar Belakang: Osteosarkoma merupakan tumor ganas primer non hematopoietik tersering pada tulang. Berbagai faktor telah dikaitkan dengan perkembangan dan prognosis pasien osteosarkoma, Salah satunya adalah mutasi gen p53 yang menyandi protein p53. Tinjauan pustaka ini bertujuan untuk mengevaluasi peran p53 dalam progresif dan prognosis osteosarkoma.

Metode: Tinjauan pustaka yang relevan dilakukan untuk menguraikan keterlibatan p53 dalam osetosarcoma. Sebanyak 22 literatur yang diterbitkan berkualitas dari 2006 hingga 2017 dikumpulkan dari beberapa basis data elektronik serta pencarian manual dan dimasukkan dalam ulasan ini.

Hasil: P53 mempunyai peranan yang sangat penting dalam menjaga integritas genom melalui kemampuannya untuk menginduksi gen-gen yang terlibat dalam proses penuaan sel, perbaikan DNA maupun apoptosis. Hilangnya p53 menginduksi sel-sel progenitor osteosarkoma untuk berproliferasi dan mengalami gangguan diferensiasi sehingga meningkatkan potensi transformasi keganasan menjadi osteosarkoma. Kehilangan p53 juga meningkatkan progresivitas osteosarkoma melalui peningkatan proliferasi dan penyediaan lingkungan mikro yang baik bagi sel tumor. P53 menyebabkan hambatan fungsi protein penekan tumor lainnya yaitu BMP-2 dan CD137L. Kehilangan p53 berperan dalam menyediakan lingkungan mikro yang baik untuk sel-sel osteosarkoma untuk menginvasi jaringan sekitar, bermetastasis dan menghambat aktivitas sistem imun melalui peningkatan aktivitas SDF-1, HIF-1α, VEGF, dan NO. Ekspresi p53 mutan yang tinggi memiliki hubungan positif dengan angka harapan hidup jangka pendek namun tidak memiliki hubungan yang kuat untuk memprediksi harapan hidup jangka panjang.

Kesimpulan: Gen p53 memiliki peran penting dalam progresivitas dan prognosis osteosarkoma melalui peningkatan proliferasi dan menyediakan lingkungan mikro yang baik untuk sel tumor.

Durasi penggunaan lensa kontak dengan resiko terjadinya keratitis: tinjauan pustaka

Introduction: An increase in the incidence of refractive disorders provides an increasing need for visual aids such as glasses and contact lenses. The use of long-term contact lenses provides a new problem which is adana keratitis which can arise with prolonged use of contact lenses.

Objective: The literature review this time aims to provide a review of how long the role of contact lens use is at risk for keratitis.

Conclusion: Extended use of contact lenses can increase the risk for corneal keratitis. The choice of contact lens type characteristics and duration of use is a matter that should be observed to avoid the risk of keratitis.

Pendahuluan: Peningkatan kejadian kelainan refraksi memberikan semakin tingginya kebutuhan akan alat penunjang pengelihatan seperti kaca mata dan lensa kontak. Adanya penggunaan lensa kontak jangka panjang memberikan suatu masalah baru yang yaitu adana keratitis yang dapat muncul dengan lama penggunaan lensa kontak.

Tujuan: Tinjauan pustaka kali ini bertujuan untuk memberikan suatu ulasan mengenai bagaimana peranan penggunaan lensa kontak yang panjang terhadap risiko dari keratitis.

Simpulan: Penggunaan lensa kontak secara extended dapat meningkatkan risiko untuk terjadi keratitis kornea. Pemilihan karakteristik jenis lensa kontak dan durasi penggunaan menjadi hal yang patut dicermati untuk menghindari risko keratitis.

Periodontitis as early detection of diabetes mellitus: a literature review

Background: Diabetes mellitus (DM) is a growing health problem and its prevalence is dramatically increasing, particularly in Indonesia. It can affect every organ in the body, and one of the oral manifestations is periodontitis characterized by the loss of tissue attachment. This review aims to identify further the periodontitis as early detection of diabetes mellitus

Methods: A review of relevant literature was performed to elaborate on periodontitis involvement in diabetes mellitus. A total of 25 qualified published literature of all years were collected from several electronic database and manual search and included in this review.

Results: On average, patients with periodontitis showed higher glycated haemoglobin (HbA1c) plasma levels compared with individuals without periodontitis. Diabetes and periodontitis are complex chronic diseases with an established bidirectional relationship. There is long-established evidence that hyperglycemia in diabetes is associated with adverse periodontal outcomes. Here, we show that periodontitis is an early sign of diabetes mellitus and may, therefore, serve as a valuable risk indicator. A dentist who got patient with periodontitis is a suitable location for screening for diabetes by a simple finger stick and validated HbA1c dry spot analysis.

Conclusion: Literature from a different type of study concluded that periodontitis is one of the oral manifestations that could be used as early detection in diabetes mellitus

Encapsulated liposome toward anthocyanin in Pectin-Based Dry Jelly as a management in pediatric obesity Management: a literature review

Background: In the globalization era, the high number of obesities is happened to the teenagers because of the unhealthy life-style. Obesity in the teenagers or pediatric obesity is important to be handled because it can trigger another complication that happened in the early age. This study aims to collect and analyze any source related to anthocyanin (ASN) from purple sweet potato (Ipomoea batatas L) as modality of obesity that is packaged as dry jelly.

Methods: A literature search strategy was conducted to obtained eligible source of study such as books and journals from Google Scholar, Research Gate, and PubMed. The criteria of eligible literature used in this study were articles published on 1981-2019 from different type of study. About 73 literature were used as references regarding the potency of ASN from purple sweet potato (Ipomoea batatas L) as the modality for obese people.

Results: ASN in the purple sweet potato has anti-obesity effect by decreasing the a-glucosidase enzyme and a-amylase, increasing glucagon-like-peptide-1 and peptide YY, changing the size of adipose cell, decreasing the lipogenic activity and inflammation, increasing the lipolysis and β-oxyanion adipose cell, as well as increasing the concentrate of brain-derived neutrophil factor in a brain. To increase the bioavailability of ASN, it has to be done the encapsulation with liposome base.  Modality is packaged in the dry jelly form with pectin base as a formulation in powder form taken orally. The modality consumption is 24 mg/kg of weight, however, after eating, the obese people tend to give the weight decreasing effect and cross section attractive to target modalities.

Conclusion: According to the studies, the ASN from purple sweet potato and package in Pectin-Based Dry Jelly could be used as a novel strategy in managing the pediatric obesity.

A large-liver abscess with severe anaemia in 6 years-old patient: a case report

Background: Liver abscess are infectious, space-occupying lesions in the liver; the two most common abscesses being pyogenic and amoebic. A pyogenic liver abscess (PLA) is a potentially lethal condition. This study aims to describe the signs, symptoms, and prognosis of pyogenic liver abscess in children with severe anaemia.

Case Description: Six years old boy complained about abdominal pain for 4 months before admitted to the hospital. The abdomen began to stiff 23 days before. Since 4 weeks, there was several episodes of fevers, more than 4 times but not more than 3 days, relieved by antipyretic. Every fever followed by a stomachache. His parents said he looked paler than before and his activities decreased, was sleepy and irritable. In physical examination, we found the patient looked anaemic, with a distended abdomen with hepatomegaly. Routine CBC revealed: WBC was 16.99, Hemoglobin was 5.45g/dL platelet was 796.20, iron parameters was: iron serum: 11.27 ug/dL (normal: 50-120 ug/dL) TIBC: 180 ug/dL(normal 225-450 ug/dL). A liver abscess 4.5 cm x 5.1 cm with liquefaction was obtained by ultrasound and confirmed by abdomen MSCT with contrast 4,4 x 4,3 x 6,1 cm. The patient family refused abscess draining surgery, so only conservative therapy by antibiotics was given and further followed up in polyclinic. Nine-month after therapy, follow up by ultrasound was normal.

Conclusion: The sign and symptom of pyogenic LA were non-specific; abdomen MSCT confirmed the diagnosis with contrast. The prognosis was good.

Self-foreign omphalitis in adult: a case report

Introduction: Severe omphalitis in adults is rare and can be caused by both congenital and acquired etiologies. We are reporting an impacted self-foreign-body in omphalitis case induced by accumulated keratin fragments.

Case: A 28-year-old overweight male presented with a 3-day history of persistent purulent umbilical discharge with a remittent fever a few days before, constant abdominal tenderness with edema and erythema around navel area. There were no other GIT-related symptoms. He was given oral antibiotics, which showed no improvement. Upon surgery, we examined deep umbilical cavity without urachal connection to the navel. From the umbilical cavity scooped out multiple polypoid umbolith debris. Histopathologic examination revealed pyogenic granuloma with numerous keratin fragments without any foreign bodies.

Conclusion: An impacted and infected self-foreign-body may be a cause of omphalitis in adults and could lead to severe and wide-spread infection if left untreated.

Penyakit Ginjal Kronik Stadium V Akibat nefrolitiasis

Background: Chronic kidney disease (CKD) is a kidney disorder characterized by abnormality in kidney structure and its function for more than three months, or decrease of glomerular filtration rate less than 60 ml/minute/1.73m². The cause of CKD including hypertension, diabetes mellitus, obstruction in urinary tract and infection.

Case description: male 34 years old hospitalized with chief complaint of nausea and vomiting since 10 days before admission. The patient also complained of pain in the right flank since one year. The urination tend to decrease since one week before admission. Phsyical examination found the patient in moderate illness, anemic in conjungtiva, pain in costovertebral angle with edema in inferior extremities. Radiology examination revealed nefrolitiasis in right region, grade II hydronephrosis caused by stone in distal ureter and cystitis. Abdominal CT-Scan revealed mild hydronephrosis caused by stone in pyelum, with nephrolithiasis in right part.

Conclusion: Chronic kidney disease is an injury in kidney which occur for more than three months, according to pathological abnormality or kidney injury marker like. Its management renal replacement therapy, diet for CKD patients, and controlling the hypertension (its comorbid condition).

Latar belakang: Penyakit Ginjal Kronik (PGK) merupakan suatu gangguan pada ginjal yang ditandai dengan abnormalitas struktur dan fungsi ginjal yang berlangsung lebih dari tiga bulan, atau penurunan laju filtrasi glomerulus kurang dari 60 ml/menit/1,73 m².

Deskripsi kasus: Seorang pasien laki-laki usia 34 tahun dirawat dengan keluhan utama mual dan muntah dialami sejak 10 hari sebelum masuk rumah sakit. Pasien juga mengeluhkan nyeri pinggang kanan yang dialami sejak 1 tahun terakhir. Buang air kecil sedikit-sedikit dialami sejak 1 minggu sebelum masuk rumah sakit. Dari pemeriksaan fisik pasien tampak sakit sedang, konjungtiva anemis, nyeri ketok CVA, dan ditemukan edema pada ekstremitas inferior. Pada pemeriksaan radiologi didapatkan nefrolitiasis dextra, hidronefrosis grade II akibat batu distal ureter, sistitis. Pemeriksaan CT-Scan abdomen didapatkan kesan hidronefrosis ringan akibat batu pyelum, nefrolitiasis kanan.

Kesimpulan: Penyakit ginjal kronik (PGK) merupakan kerusakan ginjal yang telah terjadi dalam kurun waktu lebih dari tiga bulan, yang ditandai dari kelainan patologis atau petanda kerusakan ginjal. Tatalaksana yang diberikan pada pasien meliputi terapi berupa terapi pengganti ginjal, diet khusus pada pasien dengan PGK, serta pengaturan tekanan darah pasien (penanganan pada kondisi komorbid).

High ureum and creatinine level in 18-year-old male: first diagnosed with chronic kidney disease

Introduction: Chronic Kidney Disease (CKD) needs to be rapidly diagnosed and treated correctly. The classic patient characteristics were anaemia, hypertension, oedema, albuminuria and decrease of renal function.  In a few cases, CKD can occur in an atypical patient, such as in young age.

Case report: We herein report a case of an 18-year-old male with Renal failure.  The patient noted to be anaemic, fatigue, oedema, hypertension which is consisted of features typical of Chronic kidney disease.  Laboratory examination revealed low haemoglobin level, high ureum and creatinin, and albuminuria. The patient underwent hemodialysis and was given Packed Red Cell (PRC) transfusions.

Conclusion: CKD had to be suspected of all age so that it can be rapidly diagnosed and treated correctly.

Foto polos abdomen megaureter kongenital pada kecurigaan cystoma ovari maligna: Laporan kasus

Background: Megaureter defined as dilated ureter with or without dilatation of the renal pelvis and calyces.  Megaureter is a common diagnosis in children, representing 23% of children with urinary tract obstruction. The diagnosis is more common in boys than girls, and more often is on the left side.

Case description: A 17-year-old female was referred with a suspicion of malignant ovarian cystoma. On examination, the abdomen was distended.  Plain radiograph of the abdomen revealed ground glass appearance in abdominal-pelvic cavity suspected of abdominal mass. An ultrasound of the abdomen revealed moderate right hydronephrosis and severe left hydronephrosis. Abdominal CT Scan with contrast demonstrated grade II right hydronephrosis with proximal hydroureter and grade III-IV left hydronephrosis, no solid mass in abdomen. Gynecologyst suspected this patient with left ovarian cystic mass. During the operation, evaluation to obtained ovarian cystic mass was done, yet no mass was obtained. They found a left mega ureter from proximal to distal suspected of a congenital giant mega ureter, followed by left nefrectomy and ureterectomy.

Conclusion: A ground glass appearance in plain x-ray may mimicking as hydronephrosis or gynecological mass, particularly in young female patients with suspicion of abdominal mass.

Latar belakang: Megaureter didefinisikan sebagai ureter yang melebar dengan atau tanpa dilatasi pelvis renalis dan calix ginjal. Megaureter adalah diagnosis yang umum pada anak-anak, mewakili 23% diagnosis pada anak-anak dengan obstruksi saluran kemih. Diagnosis ini lebih sering terjadi pada anak laki-laki daripada anak perempuan, dan lebih sering di sisi kiri.

Deskripsi kasus: Seorang wanita berusia 17 tahun dirujuk dengan kecurigaan sistoma ovarium maligna. Pada pemeriksaan, perut tampak distensi. Foto polos abdomen menunjukkan ground glass appearence di rongga perut-panggul yang diduga massa abdomen. Ultrasonografi abdomen menunjukkan hidronefrosis kanan sedang dan hidronefrosis kiri berat. CT-Scan abdomen dengan kontras menunjukkan hidronefrosis kanan derajat II dengan hidroureter proksimal dan hidronefrosis kiri derajat III-IV, tidak tampak massa padat di perut. Dicurigai suatu massa kistik ovarium kiri. Selama operasi, dilakukan evaluasi untuk menemukan massa kistik ovarium, namun tidak didapatkan. Ditemukan megaureter kiri dari proksimal ke distal yang diduga sebagai giant megaureter kongenital, dilanjutkan nefrektomi kiri dan ureterektomi.

Kesimpulan: Suatu gambaran ground glass appearance pada foto polos dapat menyerupai hidronefrosis atau masa ginekologi terutama pada wanita muda yang dicurigai massa abdomen.